Integration into structured curricula

Our paediatric cardiology training curricula in Dublin explicitly incorporate case-based discussions as a core assessment and teaching modality (Figure 1), often alongside workplace-based assessments such as mini clinical evaluation exercise and direct observation of procedural skills.⁷ For example, we have conducted several case-based learning sessions designed to push trainees within the zone of proximal development on topics such as heart failure, using cases building in complexity from left-to-right shunts to myocarditis/cardiomyopathy and the failing transplant patient. Case-based discussions are used not only to evaluate clinical reasoning but also to explore professionalism, communication, and systems issues.

Figure 1.

Educational framework for case-based learning (CBL) in paediatric cardiology training. CBL uses authentic or simulated clinical cases to facilitate active learning, clinical reasoning, and integration of knowledge. Core components include clinical cases, facilitated discussion, predefined learning objectives, feedback, and assessment. Educational principles underpinning CBL include adult learning theory, contextual learning, active learning, scaffolding, reflection, and integration of basic and clinical sciences. CBL may be delivered through small-group discussion, conference-based teaching, simulation, and digital learning platforms. Expected outcomes include improved clinical reasoning, knowledge retention, procedural competence, decision-making, teamwork, communication, and learner engagement.

Beyond formal assessments, case-based learning has been used to structure resident “academic half-day” teaching in cardiology and other subspecialties. In one report, paediatric residents participated in dedicated cardiology sessions built around representative cases, allowing uninterrupted interaction with subspecialty faculty and targeted bridging of knowledge gaps.^{Reference Di Maria, Seltz and Schaffer8}

At the subspecialty level, an interactive multimodal curriculum for paediatric cardiology fellows combined case-based conferences, imaging review, and board-style questions. Fellows reported improved engagement and knowledge, and pre-/post-testing suggested learning gains.^{Reference Delany, Coffman, Shea and Jump9}

A particularly notable development is the integration of clinical pathways with case-based learning in paediatric cardiology residency training. In a recent controlled study from China, trainees exposed to a combined clinical pathway–case-based learning model showed higher test scores, improved skills and greater satisfaction compared with traditional lecture-based teaching.^{Reference Shen, Chen and Li10} In this study, trainees were guided through cognitive reasoning steps reflective of real-world clinical practice, e.g., combining medical history and diagnostic test results to determine treatment approach (e.g., intervention versus surgery) and indications. In the CP-case-based learning group, 37.5% of trainees scored >90 points in the summative assessment, versus 4.3% of trainees in the traditional training group, highlighting this as a successful strategy to prepare trainees for clinical practice.

Simulation-enhanced case-based learning

Simulation has become central to paediatric and congenital cardiology education. Narrative reviews and curricula in congenital cardiology emphasise the value of simulation for rare, high-risk scenarios and for team training.^{Reference McMahon, Tretter and Redington11} When simulation scenarios are explicitly framed as cases with pre-briefing, structured debriefing and linkage to evidence, they function as a powerful form of experiential case-based learning.

In a study embedding patient simulation within a paediatric cardiology curriculum, fellows participating in scenario-based simulations reported increased confidence and demonstrated modest improvements in clinical reasoning compared with traditional teaching.^{Reference Mohan, Follansbee, Nwankwo, Hofkosh, Sherman and Hamilton12} Similarly, simulation-based courses have been used to teach communication skills, such as delivering serious news in paediatric cardiology, using scripted cases and structured feedback to enhance competence in high-stakes conversations.^{Reference Crafts, Teng and Irwin13}

More recently, virtual reality-based simulation has been introduced for interprofessional education in paediatric cardiology. A 2025 study reported that virtual reality scenarios improved learners’ self-reported understanding of CHD anatomy, interprofessional communication and procedural workflows.^{Reference Ring, DeBitetto, Cheng and Yurasek14} When combined with facilitated case discussion, these technologies extend the reach of case-based learning into immersive, interactive environments.

Global and online case-based initiatives

Paediatric cardiology has also pioneered international case-based collaborations. The “Cardiology Across Continents” initiative, for example, hosts regular interactive sessions centred on challenging cases from resource-limited settings, connecting clinicians across institutions and countries.^{Reference Peck, Neal and Redington15} These sessions highlight context-specific diagnostic and management dilemmas, broaden participants’ perspectives on health systems and resource constraints, and support capacity building.

Such programmes align with broader evidence that online case-based learning can support distributed learners and continuing professional development, provided that cases are well curated and facilitation is active.^{Reference Hassoulas, Crawford and Hemrom16} For paediatric cardiology, where expertise is concentrated in relatively few centres, online case conferences and digital case repositories can help democratise specialist knowledge.

Evidence for effectiveness

Although paediatric cardiology-specific case-based learning studies are fewer than in broader medical education, the emerging data are encouraging. The clinical pathway–case-based learning study in paediatric cardiology training demonstrated statistically significant improvements in written test performance, procedural skills and learner satisfaction compared with traditional teaching.^{Reference Shen, Chen and Li10} Multimodal case-based curricula for fellows have shown knowledge gains and high ratings for relevance and engagement.^{Reference Delany, Coffman, Shea and Jump9} Simulation-embedded case-based learning has been associated with increased confidence and improved performance in scenario-based assessments.^{Reference Mohan, Follansbee, Nwankwo, Hofkosh, Sherman and Hamilton12}

Evidence for case-based learning in cardiovascular imaging

In relation to cardiovascular imaging, case-based approaches help trainees integrate image interpretation with clinical decision-making. Paediatric cardiology imaging training frameworks emphasise progressive exposure to CHD imaging cases, supervised interpretation, and demonstration of competency across echocardiography, cardiac MRI, and CT, recognising that expertise develops through guided interpretation and clinical integration rather than case numbers alone.^{Reference Srivastava, Printz and Geva17}

Evidence for case-based learning in cardiac catheterisation and electrophysiology

Procedural simulation training is an exciting area for advancement of the case-based learning model, with the potential to enhance both knowledge acquisition and technical skills for cardiology trainees. In one prospective study, cardiology trainees underwent a teaching protocol facilitated by simulated cases over 18 months. Compared with controls, the intervention cohort had higher scores on the post-simulator written assessment, transvenous pacing wire skills assessment, and intra-aortic balloon pump skills assessment.^{Reference Young, Markley and Leo18} The direct literature on case-based learning specifically in EP fellowship training is comparatively sparse, leaving opportunities for further research.

Evidence for case-based learning in cardiac intensive care unit

Direct cardiac intensive care unit-specific case-based learning studies are limited; however, critical care education literature supports case-based learning when paired with simulation for improving teamwork, crisis management, and applied clinical reasoning.^{Reference Choudhury, Flyer and McBride19} Combining case-based learning with simulation training in a cardiac intensive care unit setting is an area for future development.

These findings are consistent with systematic reviews across health professions, which generally show moderate effect sizes favouring case-based learning over traditional lectures for knowledge and skills, as well as positive impacts on motivation and satisfaction.^{Reference Maia, Andrade, Afonso, Costa, Valente and Espregueira-Mendes2} Studies comparing blended models, such as case-based learning combined with task-driven learning or flipped-classroom approaches, suggest that integrating case-based learning with other active methods may further enhance outcomes.^{Reference Liu, Zhang and Zhang20}

However, substantial heterogeneity remains in outcome measures, follow-up duration, and study quality. Long-term impacts on clinical performance, patient outcomes and systems-level indicators in paediatric cardiology are largely unknown and represent a key research gap.

Design considerations for effective case-based learning in paediatric cardiology

Based on the broader case-based learning literature and speciality-specific experience, several design principles emerge:

1. 1. Authentic, appropriately complex cases: Cases should reflect the spectrum of paediatric cardiology practice, from common lesions (e.g., ventricular septal defects) to complex single-ventricle physiology, arrhythmias and cardiomyopathies. Progressively complex case series can scaffold learning across training levels.

2. 2. Alignment with competency-based curricula: National and regional paediatric cardiology curricula emphasise competencies such as imaging interpretation, peri-operative management and lifelong follow-up. Mapping each case to specific competencies and entrustable professional activities ensures coherence and facilitates assessment.^{Reference Kim, Tretter, Wilmot, Hahn, Redington and McMahon21}

3. 3. Structured facilitation and faculty development: Successful case-based learning requires skilled facilitators who can guide discussion, maintain psychological safety, and link cases to evidence and guidelines. Facilitator guides and faculty development programmes have been proposed to support this role.^{Reference Hamilton1}

4. 4. Integration with simulation and technology: Pairing case discussions with echo and MRI image review, catheterisation tracings, or simulated procedures can deepen understanding. Virtual reality and high-fidelity simulation offer additional opportunities, particularly for rare emergencies and interprofessional collaboration.^{Reference Mohan, Follansbee, Nwankwo, Hofkosh, Sherman and Hamilton12}

5. 5. Robust assessment and feedback: Case-based assessments (e.g., structured case discussions, written cases, and OSCE-style stations) can evaluate reasoning and decision-making. Workplace-based assessments tied to real cases provide feedback in authentic settings.

6. 6. Attention to equity and global relevance: International case-sharing initiatives illustrate how case-based learning can highlight resource-sensitive decision-making and ethical dilemmas.^{Reference Peck, Neal and Redington15} Including cases from low- and middle-income settings helps prepare trainees for diverse practice environments.

Challenges and limitations of case-based learning

Implementing case-based learning at scale in paediatric cardiology faces several barriers:

1. 1. Time and workload: Developing high-quality cases, facilitator materials, and assessments is resource-intensive. Faculty with clinical and research responsibilities may find it challenging to commit sufficient time.

2. 2. Faculty expertise and variability: Not all experts are effective facilitators. Without training, discussions may revert to mini-lectures or lack sufficient structure, diluting the benefits of case-based learning.^{Reference Hamilton1}

3. 3. Assessment alignment: If high-stakes examinations emphasise factual recall over reasoning and application, learners may perceive case-based learning as less useful and consequently reduce their engagement.

4. 4. Technology and access: Online and simulation-enhanced case-based learning require infrastructure, technical support, and reliable connectivity. In some settings, low-tech approaches (e.g., paper-based cases) may be more feasible, but this can limit interactivity and reach.^{Reference Hassoulas, Crawford and Hemrom16}

5. 5. Evidence gaps: Many studies are single-centre, use surrogate outcomes (test scores, self-reported confidence) and lack long-term follow-up. Robust, multi-centre evaluations in paediatric cardiology are still relatively scarce.

Addressing these challenges will require institutional support, faculty recognition for educational work, and collaboration across training programmes.

Future directions of case-based learning

Several trends suggest promising directions for case-based learning in paediatric cardiology:

1. 1. Hybrid and longitudinal case curricula: Designing longitudinal case series that follow patients from fetal diagnosis through adolescence could help trainees appreciate the entire care continuum, including transition to adult congenital services.

2. 2. Integration with learning analytics and AI: Digital case-based learning platforms can capture patterns of learner responses and reasoning. In the future, AI-supported systems might provide adaptive cases, tailored feedback, and automated scoring of written reasoning, while maintaining human oversight.

3. 3. Global case repositories and shared curricula: International societies, training consortia and platforms such as Heart University are well placed to curate open-access case libraries, including imaging and procedural data, with annotations tied to competencies and guidelines.^{Reference Tretter, Windram and Faulkner22}

4. 4. Interprofessional and family-centred cases: Cases involving cardiologists, intensivists, nurses, surgeons, psychologists and allied professionals can better reflect real practice. Including parent and patient perspectives, especially in communication and decision-making cases, may enhance empathy and shared decision-making skills.^{Reference McMahon, Tretter and Redington11,Reference Crafts, Teng and Irwin13}

5. 5. Rigorous educational research: Future studies should employ robust designs, including randomised or stepped-wedge trials where feasible, and track outcomes beyond knowledge such as clinical performance, team functioning and patient-centred metrics.