Thursday, July 27, 2006

Interventional Cardiology Live Demo Courses

When Dr A Greuntzig first pioneered angioplasty, in 1977, he wanted to teach this new valuable technique to as many cardiologist as possible, in the quickest possible time. Dr Greuntzig had founded a new cardiology discipline (there was no interventional cardiology before 1977). So we also learnt the same way.

As noted earlier, in one of our first articles, I had led a small Malaysian delegation in 1988 to San Francisco, to attend one of these "live Demo"courses directed by Dr R. Myler (one of the pioneers, together with Dr Greuntzig). That was 1988. Angioplasty continued to innovate and there was a constant need to update interventionists on stents, other devices, and drug-eluting stents.

Yet we are very concerned with the continue mushrooming of interventional cardiology courses, sometimes as many as two courses per month being conducted in the Asia-Pacific region. Interventional Cardiology is now a fully matured discipline and innovations seem to have plateaued for the last 5 years. Is there still a need for more "live demo" courses, and in these numbers?.

This question seems pertinent as Malaysia has just held her 3rd live demo course recently. Are there dangers in present day live demo courses, knowing that the earlier pioneering courses were good as they were designed to facilitate the teaching of a new discipline to the world.

I have personally been faculty to almost 2-4 live demo courses every year for the last 10 years and have seen what live demo courses are like. They have degenerated to just show pieces for attending interventionists with minimal teaching material as many of the techniques cannot be tried by the interventionist in their own cath. laboratories? Many of these procedures should carry the warning "Don't try this at home" as there are obvious dangers if you are less experienced, or have less support equipment or have limited backup facilities, or worst yet, all of the three.

The obvious danger here is that those who are not otherwise trained attend a couple of these courses, and proclaim themselves to be trained, and qualified. Then, of course, there is the tremendous cost. Each of these "myLive Courses", I estimate, carries a budget of about RM 1 million, for an attendance of about 600 pax (3/4 are GPs and paramedics, and faculty members). This expensive exercise has to be fully sponsored by the device companies (arm twisted to cough up support) and the cost ultimately comes back as more expensive devices, paid for by the consumer. So we all troop out and put on a "hollywood-like show" for the benefit of the few, paid for by the consumer.

The angioplasty scene is mature and innovations are now few. We in Malaysia, have certainly not been very good at innovating, for very many reasons, but we sure like a show, and expensive ones too. What then is the alternative to teach and update our own practising Malaysian Interventionist, remembering that continual medical education is always good for our patients. What is the way? Watch this column for more on this but do share any ideas you may have.

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