Table 1 Pros and cons of echocardiography training using simulators: strengths and weaknesses of providing training using echocardiography simulators is summarized.

1. Safe and flexible learning: Flexibility in learning at convenient time – at the pace of learner, and safe learning environment

2. Tailored made individualized learning: Opportunity for tailor practicing as per individual’s changing needs, personalized training program with interference from clinical environment

3. Structured training: Structured training with desired scenarios to augment learning and independence from patient availability

4. Established effectiveness: Research evidence showing established effectiveness in learning echocardiography skills

5. Cases with abnormal pathologies: A large library of CHD cases allows recognition and evaluation of a wide spectrum of structurally abnormal hearts (congenital heart defects)

1. Lack of patient interaction: Lack of real challenges in patient scanning (such as patient movement, instability while scanning, adapting scanning as per patient’s position and variation in anatomy)

2. Resources: High acquisition costs for the high-fidelity simulators and costs of running the simulation program such as dedicated experts, space, time, etc

3. Skills transfer to real patients: Limited data on ‘skills transfer effectiveness’ from the simulated environment to real patients