P2.B028: Creation of A Dedicated Fetal Cardiology Curriculum For Pediatric Cardiology Fellows

Background: Pediatric cardiologists provide expertise in prenatal congenital heart disease diagnosis and management. The Accreditation Council for Graduate Medical Education (ACGME) requires pediatric cardiology trainees to have access to fetal cardiology (Fcard) training but does not outline specifics on knowledge or practice. The American Board of Pediatrics (ABP) cardiology board examination (BE) includes content on cardiac conditions affecting the fetus and newborn, comprising approximately 4% of exam weight for in-training exams (ITE) and the BE. Many categorical cardiology fellowships lack dedicated Fcard training or exposure to fetal echocardiography. We developed and implemented a didactic and case-based curriculum to address the gap in Fcard knowledge and improve our fellows’ standardized examination scores.

Methods: We developed a dedicated Fcard curriculum based on the ABP BE content outline and organized an annual lecture series for our categorical pediatric cardiology fellows from 2018-2023. The capsule curriculum consisted of 6 didactic lectures given over the course of 3 weeks with topics on fetal hemodynamics, imaging, pathology, and counseling. Additionally, 4 case-based imaging review sessions were facilitated by faculty. A survey of satisfaction, understanding, confidence, and open-ended feedback was obtained annually upon completion of the curriculum. This allowed us to evaluate knowledge and improve the curriculum content annually. The effectiveness of the curriculum was assessed by comparing the fellows' self-reported performance, knowledge, and skills before and after the course using the Wilcoxon signed-rank test. Additionally, changes in performance scores on the Fcard section of the ITE were evaluated annually, while BE scores were examined biennially.

Results: A total of 35 fellows completed at least one year of the curriculum since 2018 and 13 surveys were received. The fellows evaluated that “the course met [their] personal expectations” (median 91%, range 60-100%) and “improved [their] current knowledge (median 100%, range 76%-100%). Their self-reported scores showed improvement in their knowledge in all 5 domains (Table 1).

Upon reviewing feedback, we discovered that case-based learning was helpful in improving understanding of topics, leading to increased implementation in subsequent years. Overall, our fellows’ ITE scores were generally at or above national average. The percentage of fetal cardiology questions answered correctly increased between fellows with one exposure to the curriculum and fellows with 3 exposures to the curriculum was 65.2% to 77.3% (n=35, p=0.12). Between 2018 and 2022, the percentage gap between our graduates BE scores in fetal topics and the national average decreased from 20.3% to 10.2% (n=21, p=0.18).

Conclusion: Implementing a dedicated Fcard curriculum has demonstrated early success in increasing fellows’ confidence and overall understanding of fetal cardiac anomalies and their management. Additionally, we observed some positive changes in standardized test scores. We will continue to refine this curriculum and track scores longitudinally to ensure optimal education for trainees.