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Trust in training: The new ESC Core Curriculum in Cardiology

Cardiology has changed a lot since 2013 – so have training methods. To respond to this evolution, the ESC, in a joint effort with the Union Européenne des Médecins Spécialistes (UEMS), updated the ESC Core Curriculum in Cardiology and it has been published today in the European Heart Journal.

ESC Education Committee Chair 2018–2020, Professor Paulus Kirchhof (University Heart and Vascular Center, Hamburg, Germany and University of Birmingham, UK), explained why this update was needed: “By definition, the Core Curriculum outlines the clinical competencies that should be acquired during training in order to practise as a cardiologist in Europe. However, modern cardiovascular medicine is interdisciplinary and interprofessional,” he said. “Therefore, communicating with the patient, understanding cardiovascular diseases in the context of the patient, and explaining specialised treatments have become more important. The new Core Curriculum also focuses on these competencies, while covering all aspects of general cardiology.”

Putting together the new curriculum was a large undertaking. To ensure that the curriculum reflects modern cardiology at a very high level, including consideration of the latest ESC Clinical Practice Guidelines, a large Task Force was formed. Comprising 84 contributors, the Task Force included ESC Association liaison officers and other members of the ESC Education Committee, members of the ESC Board, and representatives of National Cardiac Societies. The Task Force is particularly proud to have collaborated with representatives from the Young Cardiology Community and also those who matter most: patients. Based on their feedback, the Core Curriculum was devised to be easy-to-use, with clearly defined tasks and clinical scenarios to ensure that training is centred around patients and their cardiovascular problems.

The 2020 ESC Core Curriculum is organised in 62 Entrustable Professional Activities (EPAs) representing clinical competencies. Professor Felix Tanner (University Heart Center, Zurich, Switzerland), Chair of the ESC Core Curriculum Task Force, explained: “We wanted to find a new, clinically meaningful way to quantify clinical competencies. The EPA system takes the individuality of learning into account and formalises it. The new approach is based on the increase in trust the trainers develop in their trainees; it allows trainees to become increasingly independent throughout the years of training and better armed to hit the ground running when they come out of training.”

The ESC Core Curriculum Task Force believes that the EPA system reflects the current way of learning in clinical practice. Each EPA has five entrustment levels that correspond to increasing independence reached by the trainee: observing the activity (level 1), activity performed under direct supervision (level 2), activity performed under indirect supervision (level 3), activity performed with distant supervision (level 4), and being able to perform the activity independently and supervise others (level 5). Each unit sets out the knowledge, skills and attitudes needed for completion of the EPA, and importantly, provides assessment tools and expected levels. “Through this holistic approach, we feel the use of EPAs generates the necessary flexibility for guiding and assessing trainees with different abilities and training needs,” said Prof. Tanner.

Prof. Kirchhof concluded, “The new Core Curriculum will help trainees not only to become highly competent, but also compassionate, collaborative, trustworthy cardiologists that are truly fit for the 21st century.”

To learn more, hear Prof. Kirchhof describe the new ESC Core Curriculum in Cardiology and read the full document, ‘hot off the press’, in the European Heart Journal or on



The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.