Current status of interventional cardiac electrophysiology training in ESC member countries: an EHRA Young EP Report

Abstract

Interventional cardiac electrophysiology (EP) includes conventional and complex catheter ablations of cardiac arrhythmias and management of cardiac implantable electronic devices. The Accreditation Committee of the European Heart Rhythm Association (EHRA) has previously provided cardiologists interested in becoming clinical electrophysiologists with specific curricula, defining requirements both for training centres and trainees.1 Indeed, the presence of a structured EP training programme is of utmost importance in order to ensure high-quality training and comply with the requirements. Nevertheless, so far, very little information is available on EP training status across European Society of Cardiology (ESC) member countries.2,3 Therefore, the purpose of this survey was to obtain detailed information on educational EP training in ESC member countries and to assess the need of certification after completing the EP training. The present survey was conducted by the EHRA Young EP Committee from November 2017 to May 2018. Thirty-seven EHRA Young EP National Ambassadors were contacted to complete the survey. They were contacted by e-mail and/or phone and asked to answer a questionnaire containing information on the status of EP training in their specific country. The following parameters were queried: age at the beginning of medical studies, duration of medical studies, age at the beginning of cardiology training, duration of internal medicine training (if any), duration of cardiology training, features of training (duration/type/level/location), research activities performed during training, proportion of subjects performing a training abroad, need for EP and/or cardiac pacing (CP) certification after completing the training, mean number of centres per country accredited for EP/CP training, institution responsible of the certification (EHRA/National Societies/others). A total of 31 EHRA Young EP National Ambassadors completed the survey (84% response rate). Of the respondents, seven were female (23%). They represented the following ESC member countries: Algeria, Austria, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Israel, Italy, Latvia, Lebanon, Lithuania, Malta, Norway, Poland, Portugal, Republic of Ireland, Romania, Serbia, Slovenia, Spain, Sweden, Switzerland, and United Kingdom. The information provided was based on the National Ambassador’s personal experience or on the mean value of data provided by additional young electrophysiologists who recently completed their training in the country or abroad. Descriptive statistics were analysed using SPSS V.24.0 (SPSS Chicago, IL, USA). Specific features of Cardiology and EP training are listed in Table 1. Mean age at the time of the beginning of medical studies was 19 years, ranging from 17 to 21 years. Mean duration of medical studies was 6 years, typical for ESC member countries. Internal medicine training was required in 27 countries (87%), with a mean duration of 2.5 years (range 6 months to 6 years). The mean age at the end of the cardiology training was 31.6 years, ranging from 27 to 40 years. The mean duration of EP training was 2.5 ± 1.1 years. Structured EP and CP training programmes were offered only in half of countries (49%). The mean number of centres accredited for EP/CP training per country was 10 ± 31 (range 0–149) (Figure 1). A formal EP/CP subspecialization was required in nine countries (29%) and had a mean duration of 2 years. Research activities were requested in about half (48%) of the countries as part of the training. Finally, there was a considerable variability regarding trainees attending an EP training abroad: 55% of the EHRA Young EP Ambassadors declared a rate of less than 20, and 42% of them reported a rate of greater than 50%. Cardiology and EP training features CP, cardiac pacing; EP, electrophysiology. Cardiology and EP training features CP, cardiac pacing; EP, electrophysiology. Number of EP training accredited centres per country. Reported data refer to the number of centres per 10 000 000 inhabitants in each country. Blue colour refers to centres accredited by their national society; red colour refers to EHRA Recognized Training Centres. *Centres with unavailable information. Six ESC member countries (Bulgaria, Estonia, France, Israel, Portugal, Serbia) (19%) require trainees to obtain certification by the respective National Society after their EP/CP training. None of the National Ambassadors reported obligation for the EHRA certification. Nevertheless, most of the EP trainees (72%) voluntarily take the certification exam after finishing their training. The responsible institution covering the costs of the certification was EHRA in 15 countries (68%) and the respective national society in seven countries (32%). This report highlights several features of the status of EP training in the ESC member countries: (i) a relatively high age of trainees initiating an EP training, (ii) high heterogeneity in the type and duration of training offered by each country, (iii) lack of centres offering a structured EP training programme in many countries, and (iv) request of EP/CP certification after completing training only in a minority of centres. All these aspects are of particular relevance when considering the development of structured EP training programmes and the subsequent individual EP career building. In this survey, the mean age of a cardiologist starting an educational EP training programme was 32 years; therefore, the age cut-off for definition of a young electrophysiologist should be defined accordingly. EHRA can play an active and important role in ensuring the achievement of a proper and homogenous EP training level across all ESC countries. Indeed, recently, EHRA supported good educational practices provided by centres by offering training fellowships programmes in EHRA Recognised Training Centres (ERTC). EHRA strives to maintain the highest standards in education and career development. So far, a list of 21 ERTCs using advanced and uniform teaching techniques has been provided. Moreover, EHRA EP training fellowships and proctor programmes have played a crucial role especially in countries with EP under development with a limited access to structured EP training programmes. In addition, EHRA Young EP Committee and the National Ambassadors can have an important role by highlighting potential training obstacles and issues experienced by trainees in each ESC member country, as they are the most involved stake holders in this training process. Finally, obtaining an EHRA certification after completing the training is demanded being a proof of achievement of practical experience and knowledge in cardiac devices and cardiac electrophysiology, and could guarantee high-level competence, knowledge, and skills of the trainees, supporting improved quality arrhythmia healthcare throughout the European countries. Nevertheless, further efforts are needed to continuously improve and develop activities related to EP training and networking within the EHRA Young EP community that will likely contribute to the improvement of the quality of EP training and early career building of young electrophysiologists. Considerable heterogeneity is present across ESC member countries with respect to access and specific characteristics of EP training. EP/CP certification after completing EP training is requested only in a small proportion of countries. However, most of the trainees voluntarily take the certification exam by EHRA or their national societies. Nevertheless, further efforts to harmonize EP training, and certification requirements across ESC member countries are warranted to improve and homogenize EP quality of care. Conflict of interest: none declared.