We thank Dr Anderson for his interest and thoughtful commentary on our article entitled “Assessment of the need for a cardiac morphology curriculum for paediatric cardiology fellows”. We appreciate his insights into the execution of the curriculum on which we are embarking on the basis of this published needs assessment. We also hope that this endeavour will have implications beyond the United States’ training programmes, although for simplicity’s sake our original needs assessment focussed on fellowship education within the United States training programmes. Overall, we agree that this effort will require collaboration and assistance from those with interest and expertise in education and cardiac morphology, and we welcome anyone interested to get in touch with the authors directly.

We specifically address some points brought forth by Dr Anderson in his commentary. As our study demonstrates, the need for a common language is imperative to communication between providers. The work by the International Nomenclature Committee for Pediatric and Congenital Heart Disease serves as a basis for a common language and will certainly provide a scaffold for our curriculum. Dr Anderson goes on to describe that there are more similarities than previously understood between the two commonly used nomenclature systems – “Andersonian” and “Van Praaghian”. These similarities and differences are brought together nicely by Dr Ezon et alReference Ezon, Goldberg and Kyle ¹ in their recent atlas. We agree that the last decade has brought some consensus between the two systems. Important differences, however, continue to exist – for example, the simple classification of double-outlet right ventricle is not consistent between the two systems. Some hearts classified as Tetralogy of Fallot, secondary to mitral-to-aortic valve fibrous continuity, with the aorta assigned to the left ventricle under the Van Praagh system are called double-outlet right ventricle by the Anderson classification system secondary to the degree of aortic override (>50% over the right ventricle, despite the aortic/mitral relationship). Therefore, understanding the major features and classification schemes that govern both systems is imperative to understanding the meaning of their language. Given the widespread use of both systems, especially within the United States of America, the only way to fully prepare fellows to be successful communicators within the current paediatric cardiology community is to familiarise them with both major classification systems – in essence, making them bilingual. Although it is our hope that the International Classification of Disease (ICD-11) classifications will serve as a common language moving forward, this change will take time and considerable effort in spreading this language, the details of which are still being debated within the nomenclature committee. Therefore, although ideally our proposed curriculum would present one unified way of speaking, we think the reality of current practice necessitates our learners understanding both major systems, using the ICD-11 terminology as a guide.

Consistent with the principles of adult learning theory and appealing to the learning styles of our current generation of leaners, the benefits of a common, online, technology-enhanced cardiac morphology curriculum are far reaching, as outlined in our article. In addition, this format allows for constant curricular evaluation and revision. As such, improvements can occur in real time, respond to the changing needs of the learning community, and can be updated according to the latest discoveries in the field. This learning platform will allow us to provide a state-of-the-art, up-to-date education tool that we hope will have a wide-reaching audience. The content will be based on contributions from experts in our field and serve to unify how we communicate with each other related to cardiac malformations.

We agree with Dr Anderson’s evolving sentiments related to the utility of cardiac embryology. Understanding embryology was one of the greatest areas of need identified by our survey. We believe education regarding cardiac development can provide a sound basis for learning cardiac malformations, and we do plan to incorporate this as part of our curriculum.

Finally, the study of pathological specimens remains an essential tool in understanding the wide range of cardiac malformations. Technological innovation that will allow us to share virtual collections between institutions will be a critical component of this curriculum. Therefore, as we embark on the next phase of curriculum development, interdisciplinary collaboration will be key to accomplishing our goal of a common cardiac morphology curriculum. The International Society for Nomenclature of Paediatric and Congenital Heart Disease has provided a sound platform on which to base our efforts; now we must take their hard work and create an innovative educational product.