Introduction
Adult congenital heart disease is a growing and complex global health challenge. Due to significant advancements in paediatric cardiac surgery and medical management, most individuals born with CHD now survive to adulthood in developed countries. Reference Marelli, Ionescu-Ittu and Mackie1,Reference Moons, Bovijn, Budts, Belmans and Gewillig2 This success has led to an expanding adult congenital heart disease population, estimated to exceed 1.5 million adults in the United States alone, with similar trends globally. Reference Zühlke, Lawrenson and Comitis3,Reference Gilboa, Devine and Kucik4 This demographic shift has created an increasing population requiring specialised lifelong care. However, expertise in managing the complex needs of the population is not universally available, Reference Warnes, Williams and Bashore5 particularly in low- and middle-income countries. Reference Zühlke, Lawrenson and Comitis3 Access to specialised training and educational resources in these regions is often limited, creating significant gaps in knowledge and potentially hindering the provision of optimal patient care. Reference Kovacs, Harrison and Ministers6,Reference Gurvitz, Burns and Brindis7
Virtual education platforms offer a potential solution to bridge these geographical and resource barriers, providing cost-effective and accessible learning opportunities. Reference Regmi and Jones8,Reference Cook, Levinson, Garside, Dupras, Erwin and Montori9 Webinars have emerged as a popular format for continuing medical education, allowing for interactive learning and dissemination of expertise across borders. Reference Cook, Levinson, Garside, Dupras, Erwin and Montori9 Recognising this potential, the “Global Conversations in ACHD” webinar series was launched in June 2023 by the Mayo Clinic Florida Adult Congenital Heart Disease Program with collaboration of international sites. This initiative aimed to leverage virtual technology to deliver free, high-quality educational content on diverse adult congenital heart disease topics to healthcare professionals worldwide, with a particular focus on reaching Latin America and the Caribbean. The core goal was to enhance knowledge, foster a global learning community, and contribute to improved care for adults living with CHD.
In this report, we assessed the overall series reach; participant attendance patterns; characterising participant demographics, including prior adult congenital heart disease educational exposure; evaluating change in knowledge through pre- and post-session quizzes; and post-session feedback of the webinar series.
Methods
Initiative overview
The Global Conversations in Adult Congenital Heart Disease webinar series is a monthly case-based discussion series, led by the Mayo Clinic Florida Adult Congenital Heart Disease Program in collaboration with leading cardiology institutions across Latin America. Participating centres included Fundación Cardioinfantil (Bogotá, Colombia), Instituto de Cardiología Ignacio Chavez (Ciudad de México, México), Instituto Nacional Cardiovascular (Lima, Perú), Hospital Nacional Maria Auxiliadora (Lima, Perú), Hospital de Pediatria J. P. Garrahan (Buenos Aires, Argentina), and Hospital General San Juan de Dios (Ciudad de Guatemala, Guatemala). The series started in June 2023 and consisted of live, adult or paediatric cardiology or internal medicine trainee-led educational sessions, delivered monthly via Zoom. Participants’ data in the Global Conversations in Adult Congenital Heart Disease webinar series was collected from October 2023 to April 2025, and in this report, we present the evaluation of 19 months of this initiative.
This initiative was self-funded. No external financial support was obtained. The webinar sessions were hosted using the institution’s existing Zoom Enterprise account, which did not incur additional costs. Administrative, coordination, and organisational efforts were performed voluntarily by the authors and collaborating faculty.
Each monthly session was hosted by a rotating institution and conducted in English. The structured 60-minute format included a 30-minute case presentation, a 20-minute interactive panel discussion on diagnosis and management, and a 10-minute didactic segment. Presentations for integrated multimodality imaging, including embedded videos, to enhance visual learning. Sessions were recorded and shared with all participants to support continuous learning and institutional engagement. Pre- and post-session quizzes were used to assess educational value, and post-session surveys aimed to obtain suggestions for improvement.
Administrative support, technical setup, and session coordination were provided by the programme’s lead faculty, with audiovisual infrastructure facilitated through the home institution. No external administrative or technical resources were used beyond existing institutional systems.
The series was endorsed by the International Society of Adult Congenital Heart Disease, the Inter-American Society of Cardiology, the American College of Cardiology Florida Chapter, the Colombian Society of Cardiology and Cardiothoracic Surgery and the Guatemalan Association of Cardiology. Advertising occurred through multiple channels including X (formerly Twitter), email distribution lists, professional society listservs, and WhatsApp groups. These methods allowed broad outreach across regions; however, engagement analytics were not systematically tracked, and the relative effectiveness of each modality could not be determined. The webinar series was promoted globally through endorsing societies, professional networks, social media, and collaborating institutions. Participation was free and open to all interested healthcare professionals, including cardiologists (adult and paediatric), trainees, nurses, allied health professionals, and primary care physicians. Starting in March 2024, a formal registration system was implemented for all subsequent webinars.
Case selection and structure
Cases were submitted voluntarily by participating clinicians and centres. Final case selection was based on educational relevance and discussion value rather than a predefined curriculum or intentional escalation of case complexity. As a result, each session introduced a naturally varied level of clinical difficulty and topic diversity.
Data collection
For each webinar in the series, key attendance metrics—including registrations, unique viewers per session, and maximum concurrent views—were collected using platform analytics. Also, data on the total number of attendees across the series and their geographical distribution were compiled from analytics and registration information, where available. Voluntary demographics and pre- and post-session quizzes were electronically administered during each webinar. Demographics included the attendees’ professional roles and if they had prior adult congenital heart disease educational exposure. The quizzes consisted of two multiple-choice questions aligned with each session’s learning objectives. A voluntary, anonymous post-webinar survey gathered the participants’ feedback.
Statistical analysis
Descriptive statistics (mean, range, and percentages) were used to summarise attendance patterns and demographic data. Descriptive statistics (mean, median, standard deviation, interquartile range, score distributions via histograms, and box plots) were used to summarise the pre- and post-session quiz scores separately. The normality of the score distributions for the pre- and post-session quizzes was assessed via the Shapiro–Wilk test. For non-normally distributed variables, the Mann–Whitney U test was used to compare the central tendency of scores. A chi-square test of independence was performed to examine the association between participants’ professional role and their self-reported prior exposure to adult congenital heart disease education. Statistical significance was set at p < 0.05. All statistical analyses were performed using the International Business Machines Statistical Package for the Social Sciences for Windows, Version 28.0 (IBM Corp., Armonk, N.Y., USA).
Results
Between June 2023 and April 2025, a total of 23 unique adult congenital heart disease cases were presented in the Global Conversations in Adult Congenital Heart Disease webinar series. Each case was categorised based on the 2020 American College of Cardiology/American Heart Association guidelines for the management of adults with CHD, which classify CHD by simple, moderate, or complex anatomical complexity. According to this classification, 1 case was categorised as simple CHD (e.g., restrictive ventricular septal defect), 8 as moderate CHD (e.g., coarctation of the aorta, sinus venosus defect with partial anomalous pulmonary venous return, and atrial septal defect with severe mitral regurgitation), and 14 as complex CHD (e.g., Fontan pathway obstruction, hemitruncus, and Dextro-transposition of the great arteries status post Mustard atrial switch). Among the presenters, 11 were internal medicine residents, 7 were adult cardiology trainees, 1 was an adult congenital heart disease fellow (paediatric cardiology pathway), and 1 was an advanced practice provider. Supplementary Table 1 provides a summary of the clinical cases presented during the Global Conversations in Adult Congenital Heart Disease series, organised by presentation date, site, topic, and type of CHD.
Overall series reach and attendance trends
Figure 1 shows the attendance and registration data from October 2023 through April 2025. Although formal registration for the webinar series began in March 2024, participant data from earlier sessions (October 2023 to February 2024) were included in the dataset; these pre-registration months show full attendance, as only attendees were recorded, and registration data were not available to calculate attendance rates. Beginning in March 2024, when registration was officially initiated, attendance rates varied across the months. In March 2024, 67.3% of registrants attended the session. Attendance fluctuated in the following months, with the lowest rate observed in August 2024 (24.7%) and the highest in July 2024 (68.1%). Throughout the rest of 2024 and early 2025, attendance remained relatively stable, ranging between 44.8% and 55.2%. By April 2025, a total of 1,956 individuals had registered, of whom 1,068 (54.6%) attended at least one session.
Attendance and registration trends for the webinar series.
The figure displays monthly attendance and registration data from October 2023 to April 2025. Pre-registration months (October 2023–February 2024) show full attendance, as only attendee data were available, not registration data.
Analysis of participation across the 19 webinar sessions identified 1,068 total attendees from 64 different countries and six continents, highlighting the initiative’s extensive international reach. The geographical distribution showed significant engagement from Latin America, alongside notable participation from North America and other global regions (Figure 2). The countries with the highest representation were Colombia with 316 attendances (30.9%), Peru with 184 (18%), the United States with 144 (14.1%), and Mexico with 101 (9.9%). Other notable contributions included Guatemala (4.9%), Argentina (3.8%), and Canada (1.5%). Countries from Europe, including the United Kingdom (2.2%), Spain (0.7%), and Switzerland (0.3%), and from Asia, such as Taiwan (1.6%), the Republic of Korea (1.1%), and India (0.4%), also participated. In total, over 74% of the attendees came from Latin America and North America, reflecting strong regional interest, while the remaining 26% represented a diverse mix from Europe, Asia, the Middle East, and Africa.
Geographic distribution of webinar series attendance.
The map illustrates the global distribution of the 1,068 unique attendees from 64 countries who participated in the Global Conversations in Adult Congenital Heart Disease webinar series. The shading intensity corresponds to the number of participants from each country or region.
Webinar engagement trends
Throughout the 19 webinar sessions, real-time interaction was assessed by looking at unique viewers and the maximum number of concurrent participants. The unique viewers per session varied between 10 and 103, with the highest count occurring in July 2024 (Figure 3). Maximum concurrent views, indicating the highest number of attendees at the same time, ranged from 9 to 70, also peaking in that same session (Figure 3). The average duration of the sessions was 56 minutes (with a range of 37 to 65 minutes), showing minimal differences across the sessions. Sessions that were longer, such as those conducted in January and October 2024, did not adversely affect live viewership, indicating that participants remained engaged regardless of session length. Remarkably, sessions held from July 2024 onwards demonstrated both higher peak concurrency and longer average durations exceeding 55 minutes.
Webinar engagement trends over time.
Line graph showing the trend of unique viewers and peak concurrent views per session for the 19 webinars conducted from October 2023 to April 2025, demonstrating fluctuations in live audience engagement.
Attendees’ demographics and prior adult congenital heart disease education exposure
Attendees included individuals identifying with “Other” roles (e.g., nurses, general practitioners, and allied health professionals) (n = 74, 40.2%); adult cardiologists (non-adult congenital heart disease) (n = 38, 20.7%); paediatric cardiologists (non-adult congenital heart disease) (n = 25, 13.6%); adult congenital heart disease cardiologists (n = 20, 10.9%); adult cardiology trainees (n = 20, 10.9%); and paediatric cardiology trainees (n = 7, 3.8%). A notable proportion of respondents (n = 53, 28.8%) reported having no prior adult congenital heart disease educational exposure, while 131 participants (71.2%) reported having some form of previous exposure (e.g., conferences, rotations, and prior courses). The chi-square test found no statistically significant association between the participant’s professional role and their self-reported prior adult congenital heart disease educational exposure (p = 0.465).
Change in knowledge
A total of 120 pre-webinar quiz responses and 108 post-webinar quiz responses were collected. The distribution of pre-test scores (median 50%, interquartile range 0.5, mean 60%, and standard deviation 0.35) and post-test scores (median 100.0%, interquartile range 0.5, mean 69%, and standard deviation 0.37). Both pre-test and post-test score distributions were found to be non-normal (Shapiro–Wilk test, p < 0.05 for both). There was a statistically significant difference in quiz scores between the pre- and post-session groups (p = 0.035), indicating higher scores following the webinar.
Post-webinar survey
The assessment of webinar quality indicated positive feedback from attendees. Among 224 respondents, 75.4% rated the case presentation as excellent, and 22.3% rated it as good, indicating that 97.7% of participants found the presentation to be of high quality. Similarly, 75.0% rated the case discussion as excellent and 20.1% as good, reflecting a 95.1% positive response rate. Crosstabulation analysis showed a strong correlation between the ratings of case presentation and discussion, with 91.7% of those who rated the presentation as excellent also rating the discussion as excellent.
Analysis of 98 open-ended responses regarding areas for improvement revealed several recurring themes (Figure 4). The most frequently cited suggestion was technical issues, noted in 9 responses, related to audio quality and video clarity. Audience engagement was another key theme (6 responses), with participants recommending more interactive elements such as polls, question and answer opportunities, and chat-based discussions. Content delivery improvements were mentioned in 5 responses, including requests for clearer presentation structure, pre-shared case titles, and additional visual aids. Language and accessibility barriers were highlighted in 5 responses, pointing to challenges in understanding due to language differences and a lack of translation support. Similarly, time constraints were noted in 3 responses, particularly the need for extended discussion periods. A small subset (1 response) requested on-demand access or flexible scheduling to accommodate international time zones. Notably, most respondents (68 responses) stated there were no suggestions for improvement, indicating high satisfaction with the webinar series.
Qualitative feedback themes for webinar improvement.
Bar chart displaying the frequency of key themes identified from 98 open-ended survey responses regarding suggestions for improving the webinar series. Themes include technical issues, audience engagement, content delivery, and language accessibility.
Discussion
This study evaluated the 19-month results of the Global Conversations in Adult Congenital Heart Disease webinar series, a virtual educational initiative designed to improve adult congenital heart disease education globally. The sustained participation and positive feedback demonstrate the programme’s educational value. The key findings included: 1) the Global Conversations in Adult Congenital Heart Disease webinar series successfully reached a global audience, with over 1000 participants from 64 countries; 2) our initiative reached a significant proportion of attendees (29%) who reported no prior adult congenital heart disease educational exposure, positioning itself as a possible way to diminish the gap in global adult congenital heart disease training opportunities; and 3) the initiative was successful in increasing adult congenital heart disease knowledge among responders given the statistically significant difference in pre- and post-session quiz scores.
Our findings demonstrate considerable success in reaching a large and geographically diverse audience, with 1,068 total participants from 64 countries. The strong representation from Colombia, Peru, Mexico, Argentina, and Guatemala confirms the initiative’s potential in engaging healthcare professionals in Latin America, a key target region often facing resource constraints. Such extensive participation also highlights the unmet educational needs in these regions where adult congenital heart disease training resources are limited. Reference Zühlke, Lawrenson and Comitis3,Reference Regmi and Jones8 Notably, significant participation from the United States of America (11%) highlights the series’ broad appeal across different resource settings.
The attendance trends, showing initial dwindling numbers followed by peaks later in the series (July 2024 followed by April 2025), suggest growing awareness, improved promotion, or high interest in specific topics presented during those months. While the overall reach was substantial, only 1,068 out of 1,956 registered individuals attended at least one live session, resulting in an attendance rate of 54.5%. For example, the 2025 EP Board Review webinar series conducted by Mayo Clinic reported 188 registrations but only 32 live attendees for its first session (17% live attendance), with a majority (123) engaging through asynchronous YouTube recordings. This indicates that only a fraction of interested individuals or registrants attended each live event and emphasises the potential importance of asynchronous access via recordings, a common feature enhancing the value of virtual education, especially for busy clinicians navigating scheduling conflicts. Reference Regmi and Jones8,Reference Cook, Levinson, Garside, Dupras, Erwin and Montori9 While our study did not examine recorded viewership, it is probable that asynchronous access played a significant role in maintaining the sustained and exponential impact of the Global Conversations in Adult Congenital Heart Disease webinar series. The variability in per-session attendance reflects factors like topic relevance, speaker prominence, time zone conflicts, and clinical demands.
The comparison of quiz scores between pre-session and post-session respondents revealed a statistically significant improvement in knowledge following the educational intervention. This finding highlights the value of targeted online educational programmes in enhancing specialised knowledge levels. Similar outcomes have been reported by other studies assessing the impact of webinar-based learning among healthcare professionals. For instance, The Utility and Educational Impact of a Virtual Webinar to Deliver an International Undergraduate Cardiovascular Conference study found significant improvements in participants’ self-assessed core cardiology knowledge as well as their critical appraisal and basic science understanding. The study also reported prominent levels of satisfaction among participants. Reference Ganesananthan, Zahid and Choudhry10 In another study by McMahon et al., titled Medical Education and Training Within Congenital Cardiology: Current Global Status and Future Directions in a Post COVID-19 World, the authors highlight that with the widespread availability and global dissemination of online educational materials and the ease of access to these resources, few barriers remain to acquiring the theoretical foundations in the field of adult congenital heart disease and congenital cardiology. Reference McMahon, Tretter and Redington11 Additionally, an article on the evolution of congenital cardiology education emphasised the positive influence of video-based lectures on clinical practice and continuing professional development. These lectures can be utilised for delivering lectures to large audiences and facilitating discussion in groups. Reference Windram, Neal and McMahon12 These findings align with our results and support the integration of structured online learning modules into ongoing educational efforts for healthcare professionals.
A key strength of this initiative was reaching professionals across diverse roles, with over 25 % of survey respondents reporting no prior adult congenital heart disease education, highlighting the educational gap this virtual, accessible resource helped to address. Reference Gilboa, Devine and Kucik4,Reference Regmi and Jones8 Multiple studies from North America and Europe show persistent deficiencies in formal adult congenital heart disease training pathways. For example, Nguyen et al. found that while most North American fellowship programmes are structured as 1- or 2-year tracks, many do not have formal accreditation. Reference Nguyen, Maul, Hindes, Daniels, Gurvitz and Cook13 In Europe, McMahon et al. observed that only Germany and the United Kingdom provide national-level recognition, while most countries depend on informal, on-the-job exposure. Reference McMahon, Tretter and Redington11 In the United States, although a standardised curriculum was implemented in 2015, formal recognition is inconsistent, and significant gaps remain in advanced speciality training. Reference Ephrem and Alshawabkeh14 Cooper et al. also pointed out that adult congenital heart disease exposure during internal medicine and cardiology residency varies widely and is often inadequate, contributing to low trainee confidence. Reference Cooper, Hindes, Maul and Cook15 Our data shows no association between clinical role and prior adult congenital heart disease exposure, which emphasises these systemic gaps and highlights the value of scalable, virtual education in reaching multidisciplinary audiences with unmet training needs.
The strong Latin American panellist representation demonstrates successful global collaboration and knowledge sharing from diverse perspectives. A study by Gonzales-Zamora on the effectiveness of videoconferences as an educational tool says that telecommunication has evolved as a pedagogical approach that facilitates connections between developing nations and developed countries. Reference Gonzales-Zamora, Alave, De Lima-Corvino and Fernandez16 Similarly, an evaluation of education delivery via internet videoconferencing between Massachusetts General Hospital in Boston, MA, and Mbarara Regional Referral Hospital in Uganda demonstrated that this method could enhance educational capacity and support international collaboration between academic institutions, an important objective in the evolving landscape of global health. Reference Kiwanuka, Ttendo and Eromo17,Reference Cooper, Hindes, Maul and Cook15
In conclusion, the 19-month evaluation of the Global Conversations in Adult Congenital Heart Disease webinar series highlights the promise of virtual education in bridging global gaps in adult congenital heart disease training. These findings highlight the importance of accessible online educational platforms in enhancing speciality training possibilities, especially in resource-limited settings. The initiative successfully reached a large, diverse audience, including many participants with no prior adult congenital heart disease exposure and significantly improved knowledge among participants. Webinar-based training is a scalable and inclusive alternative to conventional approaches, providing a practical approach to augmenting adult congenital heart disease knowledge among healthcare professionals globally. Reference Hidayat and Rahman18–Reference Khan and Gurvitz20
Areas for improvement
The Global Conversations in Adult Congenital Heart Disease series received positive engagement from a diverse international audience; however, several areas for improvement were identified through participant feedback. The audio quality and clarity were identified as areas requiring improvement, highlighting the necessity for an enhanced sound system. Second, language barriers emerged as a challenge for non-native English speakers. To address this, future sessions could include real-time translation features or multilingual subtitles.
Participants also expressed the need for more time dedicated to audience discussion and Q&A, suggesting that future formats should allow extended interactive segments or post-session forums. Moreover, enhancing audience interaction (such as through breakout rooms) was highlighted as a key area for improvement, and this extended beyond the available moderated chat. Lastly, there was a strong recommendation to improve accessibility and inclusion by providing key points and educational content in multiple languages, thereby expanding reach and impact in under-represented regions.
Limitations
This evaluation has several limitations. Firstly, knowledge assessment relied on voluntary quiz completion, resulting in pre-test (N = 120) and post-test (N = 108) data from independent groups of respondents. This prevented a paired analysis to measure individual knowledge gain, which is a significant limitation in directly attributing score differences to the webinar. Moreover, quiz response rates were very low (120/1,068 = 11.2% pre-test; 108/1,068 = 10.1% post-test), raising concerns about response bias. It is possible that those who chose to complete the quiz were more motivated, engaged, or already knowledgeable, which may not accurately reflect the broader attendee population. Secondly, the lack of a control group prevents definitive attribution of knowledge changes to the webinars alone. Thirdly, participation and survey responses involve self-selection bias; attendees may be more motivated than the broader community. Fourthly, we assessed immediate knowledge acquisition, not long-term retention or clinical practice impact, which are crucial metrics for educational effectiveness. Reference Cook, Levinson, Garside, Dupras, Erwin and Montori9 Also, using only two questions to assess knowledge may not have comprehensively captured the full scope of the participants’ understanding or learning outcomes. Despite these limitations, the demonstrated ability to attract over 1,000 healthcare professionals from 64 countries highlights the power of this virtual format.
Future directions
Future iterations could benefit from enhanced interactivity (discussion breakout rooms), needs-based content tailoring, optimised scheduling/recording access, and potential continuing medical education accreditation by partnering with local medical councils, academic institutions, and professional societies to align content with accreditation standards and ensure formal credit recognition.
This may include seeking long-term funding through institutional grants, partnerships with philanthropies, or sponsorships from professional societies involved in adult congenital heart disease care. Using existing digital infrastructure, such as academic platforms, Extension for Community Healthcare Outcomes-style tele-education models, or global health networks, could reduce costs while improving outreach.
Additionally, the scalability of the programme can be improved by using asynchronous learning modules, recorded session libraries, and AI-enabled tools like real-time translation, adaptive content delivery, or automated Q&A support. These features can increase accessibility, especially in under-represented and multilingual areas, while ensuring that the educational impact remains strong and personalised across learner groups.
Long-term follow-up to assess knowledge retention and changes in practice. Standardising feedback collection will also be essential for quality improvement and evaluation of the programme’s impact.
Conclusion
The Global Conversations in Adult Congenital Heart Disease webinar series utilised virtual platforms to disseminate specialised adult congenital heart disease knowledge, successfully engaging 1,068 attendees across 64 countries and 6 continents, with particularly strong participation from Latin America and the USA. The initiative demonstrated measurable gains in participant knowledge and offers a valuable model for accessible, globally inclusive adult congenital heart disease education. Building on this foundation, future efforts should focus on expanding continuing medical education-accredited offerings and integrating adult congenital heart disease educational modules into cardiology and internal medicine training curricula. Developing a sustainable framework supported by partnership with professional societies and technological platforms will be essential to maintain global engagement and advance adult congenital heart disease education.
Supplementary material
The supplementary material for this article can be found at https://doi.org/10.1017/S1047951126111901.
Data availability statement
The de-identified participant data and data dictionary for this study will be made available to qualified researchers upon request. Interested parties should submit a formal proposal outlining their research plan and intended use of the data to the corresponding author at katia.bravo.jaimes@gmail.com. Requests will be reviewed by the study’s steering committee to ensure scientific validity and adherence to ethical principles. A signed data use agreement will be required prior to the release of any data to protect patient confidentiality.
Acknowledgements
We extend our sincere gratitude to Dr Sabrina Phillips for her participation as a panellist, to all the trainees whose efforts made this series possible as well as the participants who attended the webinars and provided valuable feedback.
KBJ and GS had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis.
Author contributions
KBJ: conceptualisation, investigation, methodology, supervision, writing—review & editing. GS: data curation, formal analysis, visualisation, writing—original draft. CEGC, EG, MVR, CPJ, JH, JACG, MM, CJM: writing—review & editing.
Financial support
The research received no specific funding.
Competing interests
None reported.
