Basic and Advanced Training in Pediatric Cardiology and Congenital Heart Disease Echocardiography: An Expert Consensus Paper from the European Paediatric and Congenital Cardiology (AEPC) Imaging Working Group and Congenital Heart Disease Shared Interest Group of the European Association of Cardiovascular Imaging (EACVI)

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Abstract
Bakcgroung: Training in pediatric and congenital echocardiography has progressed substantially over the past two decades, supported by structured recommendations in North America and Europe. However, while North American training pathways are generally more standardized and closely linked to accreditation and certification, European training remains heterogeneous. Differences in healthcare systems, regulatory frameworks, institutional organization, supervision, case exposure, and access to advanced imaging may result in unequal acquisition of competencies, with potential implications for patient care. The aim of this expert consensus document is to update European standards for training in pediatric and congenital echocardiography and to promote harmonization through a competency-based framework that complements, rather than replaces, national regulatory systems and existing certification pathways. Methods: Developed by the Imaging Working Group of the Association for European Paediatric and Congenital Cardiology (AEPC), in collaboration with the Congenital Heart Disease Shared Interest Group of the European Association of Cardiovascular Imaging (EACVI), the document defines three progressive levels of expertise: Basic, Advanced, and Specialized/Tertiary. Each level is characterized by specific competencies, indicative procedural experience, and expected professional responsibilities. Building on previous European recommendations and the recent joint statement addressing laboratory organization and service governance, this document focuses specifically on the educational pathway, progressive acquisition of clinical competencies, and assessment of individual practitioners. Results: The proposed framework emphasizes comprehensive training across the lifespan of congenital heart disease, including competencies bridging pediatric and adult cardiology. It incorporates contemporary imaging modalities, including three-dimensional echocardiography, myocardial deformation imaging, transesophageal and fetal echocardiography, and emerging blood speckle tracking and artificial intelligence applications. Minimum requirements for training centres, structured assessment, quality assurance, continuous professional development, research activity, and multidisciplinary collaboration are also addressed. Procedural volumes are proposed as indicative benchmarks to support training and assessment, not as stand-alone evidence of competence or universally mandatory thresholds. Conclusions: This consensus document provides a shared European reference framework designed to reduce unwarranted variability in training, facilitate professional mobility, promote competency-based progression, and ensure that pediatric and congenital echocardiography remain aligned with current clinical practice and technological innovation.

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