28 May 2004
-Doing the right thing vs Doing things right in Disruptive times-
Why:
“Pediatric Heart Surgeon had to have it all –the intellect and the skill, the grace and decisiveness, the sewing skill of the craniofacial plastic surgeon and the vascular surgeon, the millimetric precision of the neurosurgeon- and he had to be fast, too ../.. There was no other surgery in which precision combined with speed mattered so much. Add to that the need for imagination, and the bar began to seen almost insurmountably high”.
Objectives:
- Evaluation of Pediatric/Congenital Cardiac Surgery Training in Europe
- Propose a Training Curriculum Guidelines approved by EACTS (& National Societies)
- Consider necessities in the next 10 years
- Consider a Congenital Certification
1. Changing in Patients Surgical Population
- neonatal repair/early surgery
- adult congenital
- impact of interventional cardiology
- reduction volume/center
2. Changing in Social Regulations
- work hour restrictions
- hospital environment
- support services
3. Changing in Quality Evaluations
- case mix/severity/risk adjust
- medical scorecard (outcomes widely reported in newspapers: mortality, morbility, cost, satisfaction…)
- consumer and payer demands
- “microscope” environment
4. Changing in Cardiac Surgery Expectations
- limited job opportunities
- education vs service needs
- “Modernize Medical Careers”
- Low salaries
1. Designated “education centers”
- With a Minimal volume, outcome standards (“Optimal structures”)
- Agreed upon support services
- Regulatory Board may become necessary
2. Attract the best & brightest
- residents knowledge about
- Tracking
- Mentoring opportunities
- more inviting work environment
- less general surgery, more cardiac (US)
- more attractive to women (?)
3. Fellowship
- Direction tutor/teacher
- One or Two years full training model
- Success options
- rotation 6 months in other center (another country, if possible)
- number assistant cases
- number surgeon cases
- number open/close cases
- research work
- publish paper/meeting presentation
- involvement in support services: cardiology, ICU, perfusion/anesthesia
- quality evaluation approach
- regulate on calls
- Learn that you can’t lie to yourself because somebody dies / stress situations (self-psychological knowledge)
a. Inside EACTS
- Committees interaction: eg. Education and Manpower, Junior, Postgraduate Education, Congenital Heart Disease
- Survey members/residents (surgeons/residents expectations)
- Brainstorming session (Leipzig?)
- Highlight Congenital Teaching at Bergamo Courses (maybe special versions)
b. Outside EACTS
- Survey European National Societies (Countries needs) & European Board of Thoracic and Cardiovascular Surgeons (Individuals needs).
- Exchange thoughts/experiences with US Societies:
– The Society of Thoracic Surgeons
– The American Association for Thoracic Surgery
– Thoracic Surgery Residents Association
– American Board of Thoracic Surgery
- Paper finished by EACTS’05 meeting
- Internet: EACTS web-side for 6 months
- Final agreement by the EACTS Council mid-2006
- Publish in EJCTS
Résumé & Suggestions, with a wide participation and exchange of opinions (Surgeons & Residents, Europe & US),
Conducted by the EACTS Congenital Heart Disease Training SubCommittee,
Chaired by JV. Comas, including JL. Hamilton, SH. Daebritz
