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Serge Boveda: Simulation, PBP and the Future of EP Training · Show Me The Evidence

0:06
My guest today is Professor Serge Boveda.
0:09
Serge and I met a number of years ago when we were
0:12
developing the metrics for a cryoblation procedure.
0:16
Serge is co-headed department
0:20
in a Clinique Pasteur
0:23
He's principal investigator
0:26
for a European Commission grant on
0:29
the European Research Institute & Simulation.
0:33
And more importantly, he's president-elect
0:36
of the European Heart Rhythm Association.
0:41
Serge, you're very welcome.
0:44
Thank you.
0:45
Hi, Tony.
0:47
You're a very experienced electrophysiologist,
0:51
or an EP
0:53
So, what is an electrophysiologist?
0:57
Okay, that's a tricky question to start.
1:00
An electrophysiologist, as he says in
1:04
the name, is an electrician of the heart.
1:08
You know the heart is a muscle
1:10
that plays the role of a pump
1:13
to bring blood everywhere in the body.
1:18
For this muscle, you need blood that is brought to the
1:24
muscle by coronary arteries and you need also electricity
1:29
to make the contractions of the muscle.
1:33
What is not working with the electricity of the heart
1:39
makes the contractions too slow or too fast and at maximum
1:46
it can be a hurt arrest if it's too slow or even too fast.
1:52
And all the
1:55
pathology, the disturbances of the heart rhythm, so the
2:00
rhythm of the heart, the beats of the heart, is what an
2:04
electrophysiologist is taking care of.
2:06
So we are treating the diseases of the conduction system
2:14
that brings the electricity to the muscle, so to the heart.
2:18
This is what is an electrophysiologist.
2:21
Do I make it clear?
2:25
You make it clear.
2:26
Okay, so what training did you go
2:29
through to get to this point in your career?
2:32
I mean, I watch you training on
2:35
courses and I know you're pretty good.
2:38
So what training did you do to get to this point?
2:42
Okay, my training, to be
2:45
completely honest, this is not finished.
2:47
I'm still training today, so I
2:50
think that it's a very long venture.
2:54
My situation or the situation of the electrophysiologist of
2:57
my generation is a little bit special because we were
3:02
starting this specialty at the beginning of the
3:06
interventional phase of electrophysiology.
3:10
The operations started in the
3:14
90s, so end of the last century.
3:18
That was when I was a resident and
3:22
training at that time was very scarce.
3:25
It was nearly no centres in Europe or very few centres,
3:31
starting with an electrophysiology program and it was very
3:35
difficult to get trained at that time.
3:38
So I moved to a centre that had a program of interventional
3:44
electrophysiology in Barcelona to start training in 1993.
3:52
And during one full year, I learned in the operation room
3:58
with the pioneers of operation of this kind of operation
4:03
that were done, but at the very beginning.
4:08
Then, obviously, it was
4:12
just the first years with this
4:16
specialty, we had to improve.
4:20
And this is why I say that the training of my generation
4:25
was extremely long because we had to learn new operations
4:30
that were even not existing when we started this specialty.
4:35
So during the maybe 20 years between the 90s and the
4:41
beginning of this century until 2008, 2010,
4:48
new operations, new procedures
4:50
were invented and we had to train
4:54
all over these years without stopping.
4:58
And training at that time, honestly, was both very exciting
5:05
because we were learning nearly every day, but it was
5:10
difficult because we had to be all the time open to novel
5:18
procedures, novel strategies.
5:20
And yes, it was a very, very
5:24
interesting, very interesting time.
5:26
Today, this has changed a lot.
5:30
So I
5:33
infer from that, that the practice of electrophysiology has
5:37
changed considerably from when you're a young resident.
5:40
So what would you say are the major changes?
5:46
Okay,
5:48
I will just give you an example.
5:51
An operation of electrophysiology, an ablation, for
5:56
example, ablation of some types of arrhythmia that were a
6:00
little bit complex could last in the 90s or I would say
6:08
even about 20 years ago, it could last five hours.
6:14
Basically, the same operation today is lasting maximum one
6:19
hour, sometimes less than one hour.
6:22
So it has been a major change.
6:26
It's a completely fun work for two reasons.
6:31
Basically, first, now training is much more structured.
6:37
We have
6:38
much more accurate courses.
6:42
The theory has improved.
6:44
The way to teach also is much more standardised today.
6:52
That's number one.
6:53
Number two, the tools and the technology has changed a lot
7:00
and has improved the way of operating and making the going
7:07
faster and even more
7:09
efficiently and safely for the patients.
7:12
So I think that that's very good news,
7:15
not only for the patient because patient today is treated,
7:19
I believe, better than 20 years ago, which makes sense.
7:23
We are improving hopefully.
7:25
But at the same time, for the new generations, the new EPs
7:30
that are coming now, what we call the young EPs,
7:35
it's much easier.
7:38
It's less exciting because
7:41
it's not something completely new.
7:43
But the good news is that I believe that they are trained
7:47
in a much better way that I was trained myself because
7:52
honestly, I had to train sometimes alone because it was
7:56
difficult to find someone to work with and to teach.
8:01
So today, it's not the case.
8:04
And that's very good news.
8:06
Today, we have fellows in most of the European, big
8:10
European centres of electrophysiology.
8:13
For example, in my centre, in Clinique Pasteur Toulouse,
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we have five fellows of EPs every year
8:20
coming from all Europe, even abroad.
8:24
And
8:26
these guys are staying one full
8:28
year, one full year in the lab.
8:31
They see in total
8:34
more than 2000 ablation, 2000 operation during one year,
8:39
when at my time, 20 years ago, the biggest centre was doing
8:44
maybe 500 ablation in a year.
8:47
So now they see much more in a better way, with better
8:53
tools, probably with better proctors.
8:56
And
8:58
what for me,
9:01
I was learning in two years, today, I think that they can
9:05
learn it in six months or maybe one year maximum.
9:09
So yes, it has changed a lot.
9:12
It's a completely new world, a new paradigm.
9:16
So I mean, that leads well into my next question.
9:21
So how do you think training for
9:23
the EP, how has that changed
9:28
your leadership
9:30
in training?
9:32
So
9:34
how has the training of fellows changed?
9:39
Today's structure, we have a diploma in France, for
9:43
example, it's a full specialty
9:46
that is a part of cardiology.
9:48
So there is a track where the young
9:52
doctors go in order to learn electrophysiology.
9:57
So it's a very structured
10:00
program with teaching courses, and also
10:05
a special centers, so
10:09
expert centers where these students, these fellows are
10:15
going in order to start their training.
10:19
That's the first point.
10:22
The second point is that they we
10:25
have also new ways of teaching.
10:29
We have,
10:30
for example, simulators that were not
10:33
existing at my time, when I was a student myself.
10:38
And thanks to these new tools, we can also
10:43
make a preparation of the
10:46
fellows before entering into the lab.
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So that's a very important phase in which we can prepare
10:56
the young EPs, the young doctors
10:58
to go to the the procedure itself.
11:04
That's, I believe, a big plus.
11:07
But of course, and maybe we can discuss about that, but
11:10
simulation doesn't make it all.
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You need to
11:14
have simulation embedded into a very structured program.
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And that's maybe the core of the
11:23
question, the core of the problem.
11:25
And we have to be very careful.
11:28
So
11:30
you're the leader of the
11:33
European Commission funded grant on
11:38
European Research Institute and simulation.
11:42
Can you tell me a bit about what that's, you know, what the
11:46
goal was the function of ERIS?
11:51
Yes.
11:52
Okay.
11:53
ERIS starts from a
11:56
philosophical idea that that I had myself.
12:00
I wanted to
12:03
provide to propose something in order to avoid to the young
12:09
doctors coming out and wanting to do
12:12
this specialty to have and to leave the same
12:18
problems and the same life that I had myself for training.
12:23
So to improve the way of training,
12:26
ERIS, the European Research Institute on simulation, is
12:31
based, as it brings in the name, on simulation.
12:36
But not only on simulation.
12:38
Simulation is a part of the case.
12:41
It's only a tool that we're using in the institute
12:47
in order to improve the way of training
12:52
the young doctors, the young EPs.
12:56
Another idea about Eris, about this institute, is that
13:02
we really believe that it's important to have a platform
13:05
that is providing training for the new technologies.
13:10
We are in a field, as I was explaining before, that
13:15
electrophysiology basically has started 30 years ago,
13:19
maximum, between 20, yes, 30 years ago.
13:24
So that means that every year we're improving with new
13:29
tools, new platforms for new
13:31
operations, and this is going very fast.
13:35
Even myself, every year, I have to trade on novel
13:39
technologies, novel operations,
13:42
novel procedures, novel strategies.
13:46
All this cannot be
13:51
assumed by a global university program.
13:54
It's impossible to have a revision of the program of a
13:58
university, of a medical school every year, to
14:03
implement the novel technologies
14:06
and to change the program every year.
14:10
Because you will have some technologies that maybe will
14:14
last two, three years and then will be improved and you
14:18
have to change again the program all the time.
14:22
This is something that ERIS will take care of.
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ERIS will implement the novel technologies when there is an
14:29
evolution, when one type of operation is not used anymore.
14:34
We will skip it.
14:36
We will take the new one and the idea is to be very
14:42
adaptive to this very fast way
14:46
of evolution in our specialty.
14:49
This is, I believe, a very important
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proposal in order to get all
14:58
the new generation trained to the
15:03
more accurate and more efficient technologies that are
15:09
coming in the market every year.
15:12
I think that this is a little bit the idea of ERIS.
15:17
So is simulation, is it a tool or is it the magic bullet?
15:22
Oh
15:24
yes, of course.
15:25
Simulation is a tool.
15:26
Simulation is not, again, simulation is not magic.
15:31
Simulation is not something that will take a young doctor
15:36
and make it as an expert after a couple of hours.
15:41
Simulation has to be used as a tool, as I was saying
15:45
before, embedded in a structural teaching program.
15:49
In these fields, the best way to assess that
15:56
young fellows
15:59
are improving is to
16:02
measure all the
16:06
metrics that they are doing well or not doing well.
16:10
The simulator is helping for that because with a simulator,
16:15
you can mimic the operation without
16:19
training directly on a patient, which
16:22
today, in my opinion, is not acceptable.
16:26
It's not acceptable to train directly on a patient.
16:31
You have to start training on a simulator.
16:33
And when a simulator is providing to the teacher, to the
16:38
proctor, all the metrics that the fellow did well, then
16:44
once everything is fine, the fellow can go to the lab and
16:49
work with a proctor, again, not alone, of course, but with
16:54
a proctor work in the real life on a real patient.
16:59
No, I totally agree with you, Serge.
17:03
One of the problems though is I travel
17:04
around the world and teach on courses.
17:07
I think some clinicians think
17:10
that simulation is a magic bullet.
17:13
I don't think that.
17:14
I think it's a tool for the delivery of a metric-based
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curriculum that's derived from clinicians that are
17:22
experienced in the procedure and
17:24
preferably metric-based curriculum.
17:28
That's one of the things that ERIS
17:30
does, which I think is quite good.
17:37
ERIS has been running for about a year now.
17:43
What do you think are the major lessons learned from the
17:47
application of a standardised course using simulation?
17:54
Yes,
17:56
ERIS is still in the learning phase.
17:58
We are, as you say, very, very correctly, we are starting
18:04
by the beginning of this year, 2026.
18:08
We provided, until now, seven courses, in total seven
18:12
workshops on all novel technologies.
18:16
And we took lessons from these seven courses.
18:21
Things that worked well was the interaction between the
18:26
fellows and the proctors that was very, very positive.
18:30
The fact that the fellows could train
18:34
in a proper environment on very high quality simulators
18:40
besides faculties that were very high.
18:44
And the fact that we could measure the metrics was also a
18:49
very, very good experience and
18:52
very, very positive, I would say.
18:56
But we have to put more emphasis on this part of assessing
19:02
all the fellows based on the metrics.
19:05
What we are missing still today for some kind of operations
19:09
are the very accurate metrics that we need to
19:16
record.
19:17
We need to have all these metrics in a very proper way.
19:23
And to base the evaluation
19:26
purely on that would be a very good
19:29
point.
19:30
Another point that is missing today is
19:33
the further evaluation of the fellows.
19:36
Because these fellows, when they are finished the course,
19:39
when the course has been delivered, they have been
19:42
evaluated equitably, if I can say, just after the course.
19:47
And that's good.
19:49
That's very good.
19:50
But then they are going back to the hospital.
19:53
And what happens there?
19:54
What happens in the hospital?
19:56
Did they start working in the lab?
19:59
Did they start operating?
20:01
How much patients did they operate?
20:04
Were there with a proctor?
20:07
Are they now in the phase that
20:09
they are a principal operator or not?
20:13
What is the outcome of these
20:16
operations, et cetera, et cetera?
20:17
So all these parts, that is the follow up,
20:21
is still not completely
20:25
done.
20:25
It's not completely clear.
20:27
And we have now put a lot of effort on this.
20:31
This is not an easy way, but
20:34
this is a very interesting way.
20:37
Because I believe that here we are setting the basis for
20:44
what I would say, the 2.0 education, where we are now
20:49
basing education, not only on the theory,
20:53
on the exams, but also on the real life.
20:57
What happens next?
20:59
And this is a little bit the
21:01
journey that we want to put in place.
21:06
Now, you're president-elect of the European Heart Rhythm
21:11
Association, which is probably,
21:13
well, is one of the most important
21:16
professional scientific societies globally for EPs.
21:22
In March, you published a paper
21:28
on digitally assisted learning in cardiac electrophysiology
21:32
and cardiac implantable chronic
21:37
devices.
21:39
Can you summarise
21:41
the thrust of that
21:44
statement, what it said?
21:48
Yes.
21:49
I think that this document is very
21:52
important because, again, it's putting
21:57
basis of the new way of educating the EPs, the new
22:02
generations that are coming now of electrophysiologists.
22:07
And that's what we wanted to do in this document, is not
22:11
only to say what is working well now and to explain what we
22:17
still need to continue, but also to explain what is not
22:23
working really well and where we should improve.
22:27
And clearly, there
22:30
is a lot of room for improvement in training.
22:34
We need to use all the novel
22:37
technologies that are provided today,
22:41
like I was saying, not only on the
22:44
simulators, but also on virtual reality.
22:47
All the new ways of teaching that are interesting, we
22:51
should embrace them and take them into the training
22:56
programmes of tomorrow and still of today.
23:01
I think that we have to start today and to improve
23:06
during the next years to reach a
23:10
very high level quality of education.
23:12
But not only that, technology is only, as I was saying
23:16
before, a part of the problem, a
23:19
part of what we have to implement.
23:21
What we have to implement is also the methodology and the
23:25
way that we are assessing the new
23:28
generation of electrophysiologists.
23:31
And in this way of assessing
23:36
what we are delivering and what they are learning and what
23:41
they will use in the routine practice, there is a very
23:45
important point that you know very well, which is the
23:50
proficiency-based progression.
23:52
And this PBP should be completely linked with this teaching
23:59
programme based on the simulator in order to
24:05
learn with the fellows the way to improve their skills in
24:12
the next month or even years
24:16
after the index training programme.
24:19
I think that this is again a journey, it's not a single day
24:25
effort, it's a daily effort during months, during years and
24:30
sometimes during a complete life.
24:32
And PBP, it's a very interesting
24:37
methodology that makes it standardised because again,
24:43
when you are treating a patient, I believe that it's not
24:48
acceptable that a patient treated by one doctor in one
24:53
hospital will be treated in a different way than in other
24:57
hospitals, in other hands with another doctor.
25:01
I believe that we have to standardise the training, the
25:06
tools that we have today have a very important
25:11
benefit.
25:12
I think that they have the possibility of, let's say,
25:18
facilitate a big number, a great number of operations
25:24
because they make them simple, more simple, not completely
25:29
easy to do, but it's much
25:31
simpler than in the previous years.
25:35
And we have to take profits of these
25:37
novel technologies because they can provide
25:42
better reproducibility for the operations.
25:46
We have to take this opportunity to implement also the way
25:51
that we are training the fellows in order to provide also a
25:54
more standardised and a more
25:57
reproducible training for all the young generations.
26:01
Because at the end of the day, what we are looking for is
26:04
that all patients that will benefit from an operation will
26:09
get the same chances of success and the
26:13
same chances of not having a complication.
26:16
And if we want to have this, if we aim to reach this goal,
26:24
what we need is not only good tools that are providing more
26:30
easy operations, but also good training programmes that are
26:34
providing more reproducible learnings and more reproducible
26:41
learning pathways for the students in order to get a more
26:46
reproducible way of operating patients.
26:50
I
26:51
diverge slightly.
26:53
At what point did you get that when we were talking about
26:57
the or developing the metrics for the cryoblation or did
27:01
you get that from conversations in here?
27:04
What point did you get that?
27:08
Because you're spot on.
27:10
Because we are only you and me, I can
27:13
tell you that you are a little bit my guru.
27:16
I think that I got that.
27:18
I got that point when we discussed together and you told me
27:22
about the way that you were approaching
27:26
the not really teaching but evaluation.
27:30
And I think that that was maybe the missing link in my
27:34
mind, because I think that
27:36
personally I was prepared to hear this talk.
27:40
I was prepared to hear these
27:42
words, but I didn't get because this
27:49
is not my work.
27:50
This is what you see in a lot of years now.
27:55
And when you explain me your methodology, I said to myself,
28:00
this is what we are missing today in order to get, as I was
28:05
explaining before, the goal that we are aiming for
28:11
again, having the same chances of success and the same
28:15
chances of avoiding complications in all patients.
28:19
And this evaluation, these words, these sentences that you
28:24
told me many years ago, because it's not something that is
28:29
very recent, it's not coming from yesterday.
28:32
But when we met the first time and when
28:35
you made your point on PBP and all the
28:42
journey that you did yourself in this methodology,
28:48
I thought to myself, yes, this is really interesting.
28:52
And we have to implement this not only in the teaching
28:57
programs, but also probably in the scientific documents.
29:01
And this is why today it's something that is clearly part
29:06
and maybe at the core of the last document we have made together
29:12
with ERIS last year for training.
29:17
Were you surprised how strongly the document, the statement
29:22
about proficiency-based progression, that
29:24
this is the direction we have to travel?
29:27
Were you surprised?
29:28
I mean, I know you led it.
29:29
I was on the simulation
29:33
group,
29:35
but were you surprised that it was
29:36
so strong in terms of what it stilled?
29:39
Because it certainly sets ERA at the
29:41
forefront in the world of where we should go.
29:46
Were you surprised?
29:50
I'm not surprised.
29:52
This is something that for me, it's logical.
29:56
As a president-elect of the European Heart
30:01
Rhythm Association, I want that our association, that as
30:07
you stated rightly, is the most important profession in
30:12
Europe and one of the leaders in the world with the
30:16
Americans, obviously with the
30:18
Asians and with Latin America.
30:21
I think that we really want to be the leaders on this.
30:26
We really want to be the most advanced in the way of
30:33
preparing the new generations
30:36
because the future is not us anymore.
30:40
I'm sorry to say Tony, you and me, we are not the future,
30:43
but our responsibility is to prepare the future and the
30:48
future is the next generation.
30:51
And we have to provide them a new way of learning in order,
31:00
again, to improve the quality.
31:03
And that's for me not a surprise to have the PBP,
31:09
Proficiency-Based Progressions, inside the document.
31:14
We want to have it because we believe
31:16
that this is probably the best way to assess
31:22
the evolution and to assess the
31:26
training of the new generations.
31:28
So, yes, I'm very happy to have this in this document.
31:34
And what we need now is to explain and
31:37
is to implement in the training programs,
31:41
first in Europe, of course, but next in all over the world.
31:47
As a member of the, as one of the co-authors and as a
31:51
member of the committee that discussed simulation, I was
31:54
shocked of how forthright and how accepting the members
32:00
were in terms of proficiency-based progression.
32:03
And basically, they accepted because
32:04
of the data that was already available.
32:07
Unfortunately, that's not the
32:09
case in all scientific societies.
32:13
So,
32:15
is the Halsteadian training paradigm dead?
32:22
No, it's not dead.
32:23
I think that's,
32:26
I am someone that,
32:29
as you know, because you know
32:30
me a little bit, I like history.
32:33
I believe that it's important to take
32:36
base on what our predecessors have made.
32:42
And they made it rightly because at that time, at the
32:46
beginning of the last century,
32:49
Halstead, when he was proposing this training program,
32:53
today, it's the way I was trained myself, in fact, a few
32:57
years ago, more or less a few years, but to be a resident,
33:03
the residency program, and the way
33:06
that you are completely involved in this
33:13
world of the hospital, of the operation room, with
33:16
proctors, with generations working
33:18
together, for me, it's very positive.
33:21
And I think that the Halsteadian
33:23
training is not dead, but we have to make it
33:29
modern.
33:30
We have to use now what we have to improve it.
33:35
And even if we keep the same structure with the residency
33:40
program, with the training centres, experts working with
33:47
with young fellows in order to transmit
33:51
knowledge, I think that this is great.
33:55
But here we have to add what we propose today with the
34:01
novel tools, the simulators, but also the methodology that
34:07
is coming with these tools, because these tools without the
34:11
method to use them are not efficient.
34:15
They are not serving anything.
34:18
They are just like toys that you are providing for people.
34:23
But this is not what we are looking for.
34:25
What we are looking for is a tool that is used properly,
34:31
and also that serves for evaluating the fellows.
34:37
And this is something that we can
34:39
implement very well in the current program.
34:43
This is what
34:45
we are trying to do with ERIS, with the project of the EU,
34:52
the European Research Institute on simulation.
34:55
Yes.
34:55
I mean, I totally agree with it.
34:57
I mean, people, they look to me and they say, well, you've
35:01
just killed the Halstedian training part.
35:04
I disagree with that.
35:05
I think the Halstedian training paradigm has evolved.
35:09
And what ERIS is doing, what we're doing, it just makes
35:13
the training more efficient and effective.
35:15
And what we sent into the OR or
35:19
the cath lab is a pre-trained novice.
35:24
They know how to do the procedure.
35:25
They've demonstrated they can do it in simulation models,
35:28
but they still have to demonstrate it
35:31
in the operating room or the cath lab.
35:33
And so what we're doing is
35:36
we're shortening the learning curve.
35:40
We're
35:42
making sure that the patient is
35:44
exposed to less risk from the learning curve.
35:50
So should trainees during and at the end of their
35:56
course, should they be assessed?
36:01
Of course, they should be assessed.
36:04
Why?
36:05
Look, I take an example, a very simple example.
36:09
I'm used to take this example.
36:13
I am working and living in Toulouse, which is the city of
36:17
Airbus, planes, and nobody would take a plane with a pilot
36:25
that has not been trained and assessed properly.
36:29
So would it be fair to have a doctor that is operating a
36:35
patient for the first time without being training properly
36:40
and assessed in the right way?
36:42
No, it's not acceptable.
36:44
So, yes.
36:46
And again, yes, we have not only to train our young
36:52
colleagues with the novel technologies, with the novel
36:55
methodologies, but we have also to assess them before they
37:01
are entering in the lab for operating the patients.
37:05
This is for me mandatory.
37:07
And this is probably the basis
37:10
for the future of education in this field.
37:15
Including medicine?
37:17
It has to be acceptable.
37:20
We are professionals, we are dealing with patients.
37:23
This has to be accepted.
37:26
For me, I accept even after 30 years
37:30
of experience, I accept to be assessed.
37:33
I work with my colleagues, I work with my fellows.
37:39
When I can improve something, I will
37:41
improve it because this is our responsibility.
37:46
We are operating patients.
37:49
Again, a pilot of a plane that is not
37:54
landing properly has to change his way of landing.
37:58
If we don't operate in the right way,
38:00
we have to change our way of operating.
38:02
Yes, of course.
38:03
Assessment is necessary.
38:06
I mean, I agree with you, but you are the leadership.
38:11
And I'm not sure everybody will agree with you.
38:15
But I totally agree with you and I think it's the future.
38:19
The European Commission recently has
38:23
implemented the idea that certain professional groups
38:29
within medicine have to demonstrate, or they have to do
38:33
courses, and they have to demonstrate a
38:36
performance level to get microcredentials.
38:40
Microcredentials, I think it's a fabulous idea because
38:43
basically the microcredentials
38:46
are awarded from universities,
38:49
which means they have to be
38:52
legally accepted across countries.
38:55
Whereas today, if you do a course in Spain or France,
38:59
they don't have to.
39:00
If they're awarded through the
39:01
universities, they have to be legally accepted.
39:05
Do you think microcredentials
39:06
are a good idea or a bad idea?
39:10
No, look Tony,
39:12
it's the same microcredentials are necessary.
39:15
The university is the house of knowledge.
39:19
So the university is the place where
39:22
we have to base our training programs.
39:27
And the microcredentials
39:29
are the proof that these programs are delivered in the
39:33
right way in the house of knowledge.
39:37
And I believe that this is mandatory and Europe will
39:41
improve a lot by spreading these microcredentials because,
39:48
and this is again, you know, the
39:50
French were very in favor of equality.
39:56
It's mandatory that the patient that is treated in Spain,
40:00
in Italy, even in Ireland
40:04
should be treated in the same way.
40:06
I think that it's important that the microcredentials are
40:10
delivering also the standard, the proof that what is
40:17
delivered is delivered in the proper way.
40:19
And with a
40:22
background, the support of the university.
40:25
So yes, they are necessary and
40:28
they should be tomorrow, probably
40:33
at least this is what I hope, the basis for the education
40:38
of the new generations, because these microcredentials will
40:42
be again, the proof that all the doctors in Europe are
40:47
trained in the same way and in the proper way.
40:53
Yeah, no, I totally agree with that.
40:55
Microcredentials are a fabulous
40:57
idea, but it has to have teeth.
41:00
We need proper standardised metrics, validated metrics,
41:04
benchmarks to make sure that the same standards are
41:08
delivered across the countries.
41:10
And that's one of the things that the clinical trial within
41:13
the ERIS, I think that's one of the most important
41:16
functions to demonstrate unequivocally
41:19
that performance levels impact on outcomes.
41:27
The device manufacturers are legally, legally responsible
41:31
for instruction for use training.
41:34
Sure.
41:37
Published evidence suggests that
41:40
most clinicians on the use of devices and so on,
41:45
they don't really know
41:48
the instruction for use.
41:51
Is that a problem?
41:54
It's a big problem.
41:55
It's a major problem.
41:57
And this is again why ERIS is important and ERIS and all
42:01
these kinds of initiatives, because
42:04
the training programs will be based not only on PBP, will
42:09
be based not only on the
42:11
microcredentials, but they will also be based on the IFU.
42:16
The instruction for use have also to
42:19
be implemented in the teaching programs.
42:22
And if you don't do
42:26
the operation or the simulation phase and the training
42:31
program in the right way with the IFUs,
42:35
you will not get the microcredentials.
42:38
So that's a part of the teaching program.
42:41
Yes, this is a major problem.
42:43
All the doctors should use the IFUs.
42:47
But the company is legally responsible for it.
42:49
So how should deliver the training?
42:53
Should be the professional societies or ERIS
42:57
Obviously we should be delivered,
42:59
but the companies or the clinicians?
43:02
Who should be responsible?
43:05
That's a very, very important point.
43:08
And I believe, and this is maybe also a new way from the
43:13
Education 2.0, I would say, a new way of thinking.
43:19
I believe, and most probably I'm not the only one, that the
43:25
companies should be also involved
43:27
through the IFUs in the teaching programs.
43:32
Of course, the teaching program is the responsibility of
43:35
the university, is delivered by the
43:38
professors, is prepared also by the university.
43:43
But it shouldn't be done
43:47
with ignoring the companies and the IFUs.
43:52
The responsibility of the companies with the IFUs should be
43:56
taken in consideration and even should
44:00
be implemented in the teaching programs.
44:02
So
44:03
this is a way or so to say, in a certain way, maybe the
44:09
diplomatic way, as you would say, that we have to involve
44:15
in a certain point the companies in the teaching process.
44:21
And this is, again, what as a university we are responsible
44:29
for leading and to propose in the next year.
44:34
I believe that until very recently the university was also
44:41
working a little bit like artists, ignoring some
44:49
other partners that are important also in the teaching
44:54
journey.
44:55
And as you say, you're speaking about the IFUs, and this is
45:00
a perfect example where we should take this in
45:03
consideration and also having a dialogue, a connection, a
45:10
discussion with the companies in order to have these
45:14
implementing in the teaching
45:16
programs to speak with the same voice.
45:19
Because if we are not saying the same, then this is another
45:24
reason that the doctors are not using IFUs.
45:28
And this is why we should have a really very efficient
45:32
connection with the teaching departments of the companies.
45:36
Because the companies, all the companies, because they have
45:38
the IFUs, have teaching departments, we should have a
45:43
connection with these people.
45:46
Yeah, I mean, I think there's a competition there,
45:53
and maybe it's not that healthy, that the device
45:56
manufacturers, obviously, legally, they're obliged
46:02
to do the instruction for use, but the fact of the matter
46:05
is the evidence shows that the instruction for use as
46:09
delivered by them today is ineffective.
46:14
And I think there needs to be a conversation between the
46:18
scientific societies and the
46:20
manufacturers about the optimal way to do this.
46:24
Because legally, I mean,
46:28
the clinicians, if they deviate from the instruction for
46:32
use, they're not legally covered
46:33
by the indemnity of the hospital.
46:35
Okay, just
46:38
to finish up with
46:40
Serge, thank you.
46:43
Thank you for the conversation.
46:44
As always, it's been a delight
46:46
to talk to you and informative.
46:48
Thank you.
46:50
Thank you very much.
46:51
It was a pleasure, Tony, like always.
46:52
Thank you very much.