Paediatric cardiology has traditionally included care of patients of all ages with congenital heart disease and was originally developed by Adult trained Cardiologists who were interested in the complexities of children born with complex cardiac malformations. Many of these patients require lifelong follow up, leading to a most rewarding, close and long term relationship with patients and their families.
Higher medical training in paediatric cardiology has maintained its openness to trainees from either a paediatric or an adult medicine background, with applicants from a Paediatric background applying for posts at ST4 level and those from an Adult background applying for posts at ST3 level but then completing a years basic training in general paediatrics and neonates before commencing the Paediatric Cardiology curriculum at ST4 level. Previous experience in Paediatric Cardiology at junior level (ST1-3) is not mandatory prior to application for a Higher training position. Paediatric or medical experience up to the level of achievement of MRCPCH or MRCP remains essential. Perhaps the most important attribute of any budding paediatric cardiologist is highly developed skill in communication.
The specialty has changed considerably over recent years. In the past it has been expected that a paediatric cardiologist should be capable of dealing with every aspect of congenital heart disease from fetal to adult life with skills ranging from clinical cardiology to cardiac ultrasound and a wide variety of invasive skills such as pacemaker implantation and cardiac catheterisation. Whilst being an expert in all or most of the sub-specialties of the field had its attractions, increasing complexity of sub-specialization has made such practice obsolete.
Modern training in paediatric cardiology reflects these changes and the needs of patients. The training curriculum (current version adopted in 2010 with some subsequent alterations to mandatory requirements in 2012 and 2016) aims to produce trainees who, at the end of the first 3-year "core program" (ST4-6), are competent “general” paediatric cardiologists. This entails competence at assessment and immediate management of acute and chronic congenital heart disease with referral to a sub-specialist when appropriate – in other words, the great majority of everyday clinical care of patients with congenital heart disease. During this "Core" training, paediatric cardiologists will be exposed to basic training in the sub-specialty areas, to allow them to understand when to appropriately refer patients internally to colleagues with the appropriate special knowledge and skills. This exposure to the sub-specialty areas also allows the trainee in association with their Educational Supervisor to define a planned path for their later training at ST7-8 level. During "Core" training, all trainees will spend a period of 3-6 months attached to the Adult Congenital Heart Disease team, to broaden knowledge of outcomes following paediatric care and transition. Much of this training is based around a close working relationship with the Congenital Cardiac Surgical team, with a great deal of the inpatient workload being pre and post-operative management of surgical patients in a team based approach.
This training, known as sub-specialty training, can be undertaken in a modular approach for some sub-specialties, with an ST7 year of one curriculum and an ST8 year in another complimentary curriculum (for instance, advanced echo and advanced imaging with CT/MRI). In the invasive specialties of Interventional cardiac catheterisation and Cardiac Electrophysiology, training is expected to focus on an individual sub-speciality for the two year ST7-8 period.
The currently available Sub-specialty areas are Interventional cardiac catheterisation, Electrophysiology, Fetal cardiology, Advanced Echo, Advanced imaging (CT/MRI), Transplantation cardiology, Pulmonary hypertension management and Adult congenital heart disease. A further training sub-specialty of Inherited Cardiac Conditions is currently in development.
Due to the rare nature of some of the disease processes covered, not all sub-specialty areas are available in all of the Paediatric Cardiology units. There is currently some flexibility to allow for trainees to go Out Of Programme for further experience in a sub-specialty area that is not provided in their centre.
At the end of the training programme, once the appropriate competencies have been achieved, all trainees receive a CCT in Paediatric Cardiology. In some cases (in particular for the invasive sub-specialties) a further period of post CCT training may be recommended prior to taking up a Consultant post in the specialty.
Information is current and updated as of April 2018