fellowship.39 Transition programs ought to integrate meeting with peers in the care package that they provide.27 This could be done as part of an adolescent day27,39 or a camp.40,41 Actual Transfer to the Adult Congenital Cardiac Clinic The actual transfer from pediatric cardiology to the adult congenital cardiac clinic is a milestone in the transition This transfer usually takes place around the age of 18 years A proper handover has to be scheduled There are different ways to organize this handover It can be done by means of a referral letter including a summary of the medical history.19 However, a personal contact between the pediatric and the adult providers would be more optimal In this respect, a joint outpatient visit with the pediatric cardiologist and the adult congenital cardiologist is sometimes advocated Given the time consumption and practical difficulties to organize it, such joint outpatient visits are seldom sustainable Therefore, transition coordinators are deemed to play a crucial role For instance, at the first visit at the adult congenital cardiac outpatient clinic, the patient meets the transition coordinator, who is then joined by the adult congenital cardiologist In addition to handing over the medical file, the transition coordinator explains the issues that have been discussed and worked on during the transition Input from the patient and parents are facilitated This kind of transfer visit has been found to lower the barrier toward the adult program, and has been shown to be effective.39 Training of Practitioners to Provide Services for Transition There is a clear need to develop a new group of specialists to deal with the longterm needs of patients with congenitally malformed hearts This should include medical practitioners, specialist nurses, and allied health professionals Recent recommendations emphasize the need for training in adult and pediatric cardiology, as well as familiarity with general medical issues A particularly important role is that of the transition coordinator Whereas transition coordinators are currently trained as part of an intervention study,27 formal and structured training programs for future transition coordinators will be indispensable to safeguard a high-quality transition Such training programs should address adolescents’ health and development, communicating with and interviewing young persons, detection of and screening for risk behaviors, and patient education The provision of services with appropriately trained staff is developing rapidly in some countries but lagging behind in others.42 Such resources will affect the design and composition of the services Any necessary compromises, however, should not distract from the need to develop programs of high quality, which cover seamlessly the entire life course of the patient with a congenitally malformed heart Summary Transition of care from pediatric to adult services is a crucial period for patients with congenital cardiac disease If managed badly, patients fail to understand their disease, its impact on their life, and the need for long-term follow-up As a result, they frequently default from care, and their outcome is adversely affected If managed well, patients can be empowered to graduate from the pediatric environment to take control of their own health This ensures not only continuity of high-level cardiac treatment, but successful integration into normal adult life All systems for health care that embark on the treatment of children with congenital cardiac disease must, therefore, undertake to provide an effective service for transition to appropriate adult care ... medical practitioners, specialist nurses, and allied health professionals Recent recommendations emphasize the need for training in adult and pediatric cardiology, as well as familiarity with general medical issues A particularly important role is that of the transition coordinator... cover seamlessly the entire life course of the patient with a congenitally malformed heart Summary Transition of care from pediatric to adult services is a crucial period for patients with congenital cardiac disease If managed badly, patients fail to understand... result, they frequently default from care, and their outcome is adversely affected If managed well, patients can be empowered to graduate from the pediatric environment to take control of their own health This ensures not only continuity of high-level cardiac treatment, but successful integration into normal adult life