December 22nd, 2011
A New Brave New World? Impact of Technology on Fellowship Training
Last week, CardioMEMS failed to get approval from an FDA advisory panel for treating heart failure based on uncertainty regarding the benefit; the advisory panel also raised concerns about study bias. This intracardiac device measures pulmonary artery pressures that clinicians can use (in addition to other clinical signals, such as weight gain) to select therapies and decrease hospitalizations.
This announcement brought to my mind an issue separate from the decision and the reasons for it — the impact of technological advances on fellowship training.
As fellows, we almost all wish to be trained in the most novel techniques. Research and new discoveries are such an intrinsic part of cardiology that sometimes we might lose sight of the basics. And, a commanding knowledge of the basics and an understanding of hemodynamics, etc., are what drive most innovative thinking in the cardiology subspecialties.
We are taught in medicine to base decisions on clinical interactions with patients, rather than relying on technology to guide management. But is this how we practice or even how we should practice?
My attendings frequently impress me with their physical exam skills, but I am uncertain if their skills are better than mine because these physicians are 20 years my senior or because they did not train with the current electronic gadgets. Eric Topol of Scripps recently commented that he has not used a stethoscope in two years and instead favors a portable echo device. Similarly, many heart failure programs have incorporated computerized scoring systems to help predict readmissions and thus to decrease them.
Thus, my questions to fellows and more senior cardiologists:
- Has cardiology training lost some of its edge and intellectual nature because of the constant presence of advanced technologies, whether investigational like CardioMEMS or newly established like LVAD?
- Or do the information and clinical challenges provided by these advances sufficiently add to our training and our understanding of disease processes?
- How are fellowship programs and fellows incorporating these technologies into their training schemes? Does early adoption of the new technologies prepare or hinder fellows for real-world practice?