Rabih A. Chaer, MD
University of Pittsburgh School of Medicine
The E. J. Wylie Traveling Fellowship was conducted between June 2011 and June 2012. The purpose of the fellowship was to visit centers of excellence in peripheral interventions and meet personally with expert physicians in Europe. An additional benefit has been the exposure to new technologies and cutting edge clinical trials in the field. I am indebted to the expert physicians and their colleagues for their time, expertise, and hospitality.
The Leipzig Interventional Course (LINC)
My trip to Europe started by attending the LINC course in Leipzig, Germany. This live interventional course featured 79 live cases in 3½ days, all performed to completion according to a predetermined plan. The organization of the meeting was impeccable, and the wealth of information that I acquired from the live cases was invaluable. The ability to see live troubleshooting of difficult clinical situations, the use of different tips and tricks to successfully complete the procedure by masters in the field has allowed me to expand my armamentarium of tools and techniques to treat patients with peripheral vascular, carotid and aneurysm disease.
I was fortunate enough to also participate as a faculty speaker. As such, I was able to interact with worldwide leaders in the field, which was a unique and invaluable experience.
St. Blazius Hospital, Dendermonde, Belgium
Following the LINC course, I travelled to Belgium to spend a week with Dr. Marc Bosiers and his team. Dr. Bosiers works at St. Blazius, a private hospital located in Dendermonde, a small town centrally located between Brussels, Gent and Antwerp.
The Belgian hospitality was impressive. The organization of my trip to St. Blazius Hospital was impeccable. Immediately after my arrival to the hospital on the morning of Monday January 29th, I was given key card access to the hospital premises and joined Dr. Marc Bosiers in the angiography suite where he has an active daily limb salvage practice.
The angio suite organization and efficiency was impressive. Dr. Bosiers works with a very talented team, including a core group of partners including Drs. Deloose and Callert, a dedicated anesthesiologist, and experienced nurses and dedicated local and international fellows. Similar to the practice pattern seen in Germany, the access to new devices and technologies in Belgium was quite notable.
The team approach was unlike any other model I had seen. The camaraderie between the office staff, nursing staff, fellows and surgeons was amazing, and fosters a collegial and efficient environment where everyone is working towards the same goals. It was routine for every member of the team to break for a group potluck lunch every day in the OR suite kitchen.
The research structure at St. Blazius was impressive. The Flemish research consortium includes several centers in Belgium collaborating on clinical trials. The group of coordinators at St. Blazius lead by Erwin Vinck does an impeccable job at tying all the research efforts together and has allowed Dr. Bosiers and his group to be extremely productive and contribute landmark trials to the vascular surgery literature.
The clinical research structure was unlike any other model I had seen, not only because of the dedication and hard work of the research team, but also because of the ongoing focus of the surgeons on patient enrolment in clinical trials, whereby every single patient is considered for inclusion in one of the multiple ongoing trials.
My visit to Belgium allowed me to see a different approach to patients with critical limb ischemia, learn some subtle but valuable nuances in the way to perform peripheral interventions, and witness a well-oiled team approach on both the clinical and academic sides. More importantly, this trip has allowed me to establish an ongoing friendship with international colleagues, which will hopefully result in ongoing cultural exchanges and scientific collaborations.
Park Hospital, Leipzig, Germany
My last trip was to Park Hospital in Leipzig, where I spent two weeks with Drs. Dierk Scheinert and Andrej Schmidt and their team.
They have an extremely busy endovascular practice centered in four angiography suites. Although the bulk of their practice concentrates on peripheral interventions, they do treat patients with all types of vascular pathology. The efficiency of the angiography suite and the skills of the operators allows for a consistently busy practice into the late evening hours. The structure of the angio suite was quite interesting as every interventionalist primarily works independently: there was no assistant, no anesthesiologist, and no scrub nurse. A group of circulating nurses located in central core of the angiography suite teamed up to support all four rooms and assisted with the needed disposables. The physician was the only constant person in the room treating the patient, so the presence of international fellows was a well welcomed addition. The breadth of cases, very welcoming hospitality, and hands on experience were unparalleled and equipped me with a new set of techniques and approaches that I now incorporate in my practice. The complexity of the cases, the troubleshooting and consultation/decision making among the different operators, and hands on experience with standard and transpedal interventions added to my existing level of expertise in the field. I have also witnessed a different system and organizational structure to strive for, all geared to maximize efficiency, turnover times, and the prompt delivery of patient care. While very hierarchal and structured by seniority level, it was nonetheless a very efficient practice with seemingly minimal administrative barriers to patient care, and appeared to maximize professional satisfaction even to the relatively junior operators.
In summary, the E.J. Wylie Traveling Fellowship allowed me to visit centers of excellence around Europe where I gained first hand exposure to different types of peripheral vascular interventions. In addition, I witnessed different types of organizational systematic structures and what level of efficiency can be achieved not only for the delivery of patient care, but also to conduct cutting edge clinical trials.
Posted February 2014