Latest / European Society for Vascular Surgery / Realities of Training Young Vascular Surgeons - E. Iborra & I. Končar

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Realities of Training Young Vascular Surgeons - E. Iborra & I. Končar · European Society for Vascular Surgery

• 0:14
  Welcome back to the ESVS podcast. Today we're
• 0:17
  starting a two -part series on vascular training
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  where we'll talk with both trainers and trainees
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  across Europe to explore the current structure,
• 0:26
  the things that could use a little improvement
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  and the reality that we all live in every day.
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  Let's begin with the trainers, the mentors, the
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  consultants who somehow stay calm when residents
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  bravely pretend to know exactly what we're doing.
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  I'm joined here today by Professor Elena Iborra
• 0:46
  and Professor Igor Koncar, trainers who have
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  guided more residents than any reasonable human
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  should be expected to. And they're still here,
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  still teaching, still patient and still inspiring.
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  My name is Asia Halman and today we'll talk about
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  what good training really looks like, what trainers
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  secretly wish their residents understood and
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  why the next generation keeps everyone both hopeful
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  and mildly stressed. So let's begin with a short
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  introduction. Could you each briefly describe
• 1:17
  your current role and your involvement in training
• 1:20
  of young vascular surgeons? Hello Asia, thank
• 1:23
  you very much. I'm an associate professor at
• 1:25
  the University of Barcelona and I'm vascular
• 1:27
  surgeon at one of the leading hospitals in the
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  city. In the ESVS, I am the Aorctic Fellowship
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  lead and this allows me to contribute to the
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  training across Europe. It's been a very interesting
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  experience. First, thank you for the invitation
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  to participate in this very interesting podcast
• 1:45
  and thank you for organizing such a podcast.
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  My name is Igor Koncar, I'm vascular surgeon in
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  Belgrade, Serbia. I'm teaching vascular surgery
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  in medical university. I'm chairing the academy
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  of the ESVS, so I'm involved in organizing a
• 2:00
  lot of different workshops. And I'm also educating
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  as a proctor for companies, for the Stengrafts.
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  I go in different hospitals and I teach and help
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  other colleagues to perform EVAR and TEVAR. It
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  is really wonderful to have you both here and
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  thank you again for joining us. Let's talk the
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  foundation. Elena, when a new resident enters
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  the program, what do you expect from them? And
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  what should they expect from their trainer? When
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  you have a new resident, you expect them to be
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  curious and have a desire to learn and try to
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  commit with the team. You expect them to have
• 2:40
  responsibility and show a lot of empathy with
• 2:43
  the patients. And the trainer... I think that
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  the trainers should guide and support and communicate
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  well with the trainees. I think that training
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  is kind of a shared journey because while the
• 2:55
  trainee is learning, the trainer learns as well.
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  In that case, what defines a great trainer? Is
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  it about the surgical skill, attitude, structure,
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  or maybe something completely different? Igor,
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  what are your thoughts? Great trainer, I think,
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  should first be a good example. So by performing
• 3:17
  procedure, but also working, doing everything
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  he or she is doing in his career, it should be
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  example to others how to do. Then good trainer
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  should dedicate time for training. A good trainer
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  have to understand the level of knowledge of
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  listeners. It's very important because we are
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  addressing in a different manner. Audience will
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  be for a level of knowledge. Also good trainer
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  needs to know when to summarize. And of course
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  trainer has to have a wider knowledge about medicine
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  and all other things. Sounds like being a good
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  trainer is a lot of work. So how do you approach
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  progressive training? Specifically, how much
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  structure should be in place in terms of content,
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  autonomy and hands -on time? I think good plan
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  is important. Are we talking about a short two
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  -hour workshop or we are talking about the whole
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  five years training? Everything should be well
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  planned and everything should address the level
• 4:22
  of audience and level of trainees. Hands -on
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  time is very important, but I think theory is
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  also important as well. So I don't see a point
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  going into the hands -on without actually knowing
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  all the background theory. And this sometimes
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  should be maybe tracked with the different tests
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  and should be evaluated during the training.
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  And then planning every education, we need to
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  dedicate time for this particular education.
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  So now that we talked a little bit about the
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  structure of the training, how do you make sure
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  your trainees receive a meaningful feedback?
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  How do you track their progress? Well, sometimes
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  giving feedback is not easy, but we as trainers
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  should make some effort to give the trainees...
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  every kind of feedback, but in kind of respectful
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  manner that everybody can be open to that. I
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  try to make some regular one -to -one conversation
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  with every one of the trainees and also the members
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  of the staff to know their progress and their
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  challenges and their goals. Every person is different.
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  It's also interesting to have kind of a structural
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  evaluation, considering the different stages
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  that the trainee has to go. That kind of feedback
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  is something everyone should have. in their center.
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  Thank you Elena. So we all know being a good
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  trainee isn't just about passing the exams. It's
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  about growing into thoughtful and well -rounded
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  surgeon. So what should trainee be doing outside
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  of the OR to deepen their knowledge? Well the
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  thing is that in the or you have to practice
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  and learn but it's not the way that you have
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  to train things at the beginning so these videos
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  that we can find online the guidelines uh many
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  ways that you can see an operation from a video
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  from a video before you go there and so i think
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  that it's a it's kind of a way to to learn a
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  lot also attending to conferences and try to
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  participate in the discussions when sometimes
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  in big conference is not easy because you're
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  thinking that you cannot do that but you have
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  to use the workshops or the smaller meetings
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  try to participate and share the knowledge and
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  another thing that maybe is very good for the
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  trainees is try to teach others the older trainees
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  teaching the younger ones and also the students.
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  I think that it's a great opportunity to check
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  on your own knowledge and to check how to give
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  this knowledge and how to mentor other people,
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  younger people. And if you were a trainee today,
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  how would you approach your learning? It is important
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  to learn from different sources. Visiting different
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  centres is important. And I think in the different
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  stages of your career, you should plan this kind
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  of visiting differently. At the very beginning
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  of the career, in the early stage, I think longer
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  visit is very important. Because if you need
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  more time to take some skills, to learn more,
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  to see more in the centers, then once we are
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  getting more... uh skill you have more knowledge
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  we have more experience we have more questions
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  about specific pathologies algorithms strategies
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  then i think visiting for a shorter period like
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  one month or even less is that good good time
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  because then you can learn specific technique
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  or specific technology and come back to your
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  center where you work and you continue to to
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  use it and then at a more uh later stage stage
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  i think also visiting other hospital is important
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  that we are not trainees anymore we are experienced
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  surgeons but still i think even in that phase
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  we need to learn and even in that phase visiting
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  any other center for one day or day and a half
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  it's also it's it's enough and it's very very
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  much useful trainees should have a goal uh goal
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  in in career asking himself where I want to be
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  in five years, where I want to be in eight years.
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  And nowadays, of course, we have this differentiation
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  between arterial and venous. We have differentiation
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  between open and endo. And not everyone is a
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  fan of being multi -skilled, doing all, doing
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  a lot of procedures. Some surgeons want to dedicate
• 9:13
  to a certain pathology or a certain procedure.
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  Some others are multi -skilled, they want to
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  know more, they want to perform different procedures.
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  And sometimes in our career, we need to have
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  skills to do more. So in your career, you should
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  actually see which kind of person you are and
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  what do you want. Do you want to work in a high
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  -volume center, in a tertiary center, where complex
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  procedures are done, but long? Or you want to
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  do less? shorter procedures but you know more
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  procedures more private academics so there are
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  different actually paths in our careers and i
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  think choosing specific paths actually can guide
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  us in a different training kind of models so
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  that brings me to my follow -up question do you
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  think in the future we will be able to perform
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  both open and endovascular procedures or will
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  there be specialized surgeons for both approaches.
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  I would ask you what endo and what open. I think
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  some of vascular surgeons will be able to do
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  I would say basic endo and basic open but then
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  when it comes to more complicated things some
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  would be able to do more complicated endo and
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  some would be able to do more complicated open.
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  but also i'm sure there will be surgeons that
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  will not be able to do any open or any endo because
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  actually they don't work in the hospitals that
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  they have uh such a volume of procedure so and
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  this is why i said in the previous answer so
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  it depends where you work in which country and
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  you actually need to estimate the future of of
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  your you know environment how it will change
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  and give yourself some goals, where you want
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  to work, what you want to work, and then go more
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  for education. But also in the middle of career,
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  on your later stage of career, I think there
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  is a place that we can also shift. We can educate
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  more. We can go for several months in another
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  center. We can go for more workshops and then
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  we can adapt more skills and change. So I don't
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  think this is like something that we defined
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  in the early stage and we don't change until
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  the... Retirement, I think this is a dynamic
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  process that depends on how we work, where we
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  work, it can change. So beyond the standard curriculum,
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  what are the experiences, procedures or settings
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  that you believe every vascular trainee should
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  actively seek out? I'm thinking here not just
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  of rotations, but also exposures, new technologies,
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  innovation hubs or international fellowships.
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  that might not be a part of formal program but
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  can expand the surgical mindset i always encourage
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  the trainees to explore beyond the standard curriculum
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  try to go to international meetings on or try
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  to check on possibilities of knowledge like workshop
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  fellowships or anything else I think that a great
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  opportunity is to work with other disciplines,
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  with other specialists. Future vascular surgeon
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  has to be open to new techniques like robotics.
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  On the ESVI website you can find a network, you
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  can find a map of different centers and there
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  you can find basic information about what these
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  kinds of centers can offer. I cannot give you
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  any particular center because... depends on what
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  you want to learn in my institution in my department
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  every uh vascular surgeon during the training
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  goes in a different european center for at least
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  one month and to see what we can learn as a center
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  from there how we can adopt their techniques
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  there we were struggling with for example with
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  custodial So one of the goals of our training
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  was to go there and see how Milano group is using
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  Custodio, but also to see other techniques there
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  and to learn from them. So when our training
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  came back, it was good for him, but also it was
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  good for us. Thank you. So we obviously talk
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  a lot about surgical skills, technical skills.
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  How about the so -called soft skills? Should
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  we... teach them more, less? Should we have a
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  structured training? What are your thoughts on
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  that? I think that is the future, that the future
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  doctor or surgeon has to be very good communicator,
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  they have to be a leader. It's very common to
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  learn by examples, to learn working with the
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  others, but we should try to give kind of structured
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  training in these kind of aspects of our life.
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  Sometimes you're not a good leader. basically
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  but you can learn how to do that i think that
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  a good thing is to train this kind of soft skills
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  yeah that that is definitely what what we need
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  and modern vascular surgeon needs these skills
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  it's difficult to put everything in the program
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  it's difficult to you know learn everything but
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  definitely it's necessary and so i think everyone
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  should actually choose some of those skills,
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  some of those educational contents and go for
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  it and learn it. But definitely we need all those
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  soft skills. So what are the habits or behaviors
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  that distinguish the truly excellent trainees?
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  I think that a very good trainee are people that
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  are respectful with the patient and with the
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  rest of the team. They must be empathetic and
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  try to put themselves in the other's places because
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  it's the way to understand the others and I think
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  that it's kind of mandatory to understand the
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  patients and the other colleagues. They must
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  be proactive and reflective, have to know why
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  are they doing the things that they're doing,
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  why are they acting the way they're acting. And
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  they must be humble. I consider that you have
• 15:28
  to be in your place. They should ask questions
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  and look for feedback and support for their colleagues.
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  Thinking about the whole team, because it's the
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  way that all together can grow and be better.
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  They have to try to use the time wisely, because
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  I think the time for the residency is very short
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  at the end. You think that it's quite long, because
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  there are five years or whatever. But I think
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  that... this time is so short that they have
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  to use their time very wisely and not worry about
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  what they don't know but they have to think that
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  they have a lot of opportunity to learn and even
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  in a in a simple case they can learn a lot that
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  no one is born knowing everything and the best
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  thing they must understand that they have to
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  be open curious and willing to learn from every
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  little experience Thank you. And we talked with
• 16:27
  Elena a bit about excellent trainees. I think
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  you get the harder question because my question
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  is, what are the red flags of the trainees? Not
• 16:35
  like small things being late sometimes, but behaviors
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  that really make compromise their professionalism.
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  I think hard work and dedication is very important.
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  I don't see that we can actually learn and acquire
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  everything we want because here we discussed
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  a lot of things. And I don't think this is possible
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  to accomplish in the working hours. I don't think
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  this is possible to accomplish without sacrificing
• 17:08
  some parts of our lives. And I think this is
• 17:13
  not possible without really passion and enthusiasm
• 17:16
  for our work. So we have to have spark in the
• 17:19
  eyes when we see a good case. We have to have
• 17:22
  this kind of passion about new technique, new
• 17:25
  technology. We have to have, how to say, wish
• 17:33
  to stay after hours and see something interesting
• 17:35
  in our profession, some new lectures, some new
• 17:40
  procedure. So this is what actually everyone
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  needs. from my perspective, to accomplish what
• 17:50
  is called good Finnish training. Of course, it's
• 17:54
  not possible without trainers, without teachers,
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  but training is sparking the eye, enthusiasm,
• 18:04
  hard work and dedication. That's for sure. And
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  have you ever had a trainee that was struggling
• 18:09
  at the beginning and then managed to turn things
• 18:12
  around? I think that... every trainee has struggling
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  in in sometimes and i think that the majority
• 18:19
  of them turn things around the the fact that
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  makes the difference is probably is openness
• 18:27
  and the willing to communicate their needs if
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  if you i if i'm struggling and don't say to anybody
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  i cannot seek for help so if you communicate
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  to the others if you have problems what are your
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  needs probably is better to it will be better
• 18:43
  for you and for the others so you have to accept
• 18:45
  the help and try to adapt to that and accept
• 18:49
  the accept the feedback and try to change make
• 18:51
  the small changes that sometimes make that you
• 18:55
  live better and and live this struggling it's
• 18:58
  normal for a trainee have difficulties it's kind
• 19:01
  of natural for the experience but you have to
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  be committed to to improve and If you communicate
• 19:08
  to the others your problems, you can work together
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  and try to go better and turn the things around.
• 19:15
  And looking forward, what would you like to see
• 19:18
  change in a vascular training? Do you have something
• 19:22
  in mind, some ideal training pathway? Training
• 19:26
  should be more tailored to the individual person.
• 19:30
  We need to understand our trainees because every
• 19:32
  person is different. They have some strengths
• 19:34
  and challenges and aspirations. Not everybody
• 19:37
  wants everything. So my ideal pathway should
• 19:41
  be flexible and kind of personalizing. Sometimes
• 19:44
  it's not easy to do that because sometimes there
• 19:46
  is not much time to try to understand everybody.
• 19:50
  Let's look outside of the hospital for a moment.
• 19:53
  What can societies do? Do you see any role of
• 19:56
  the society in a vascular surgeon's training?
• 20:00
  Societies are part of the training, a training
• 20:04
  program. It's part of our lives, but I'm not
• 20:08
  sure that they are the main part of the training.
• 20:11
  The main part of the training should be in the
• 20:15
  hospitals, in the centers, among the local faculties.
• 20:20
  Also local societies can probably help a bit
• 20:24
  more than European society. So European society
• 20:27
  is just a roof. Society like ESVS can guide,
• 20:31
  can make recommendations, can record such a podcast
• 20:37
  and make suggestions what can be done. ESVS is
• 20:43
  supporting actually doing a lot of workshops
• 20:46
  in the annual meeting, but also outside. We are
• 20:49
  now organizing a lot of local workshops, which
• 20:52
  is really helpful. And this can be helpful, but
• 20:56
  without local support and local dedication to
• 21:01
  education, it's not possible. So we all have
• 21:05
  to work together. And I think it depends on the
• 21:08
  level of the... career, some parts of this building
• 21:15
  are more or less important. And that concludes
• 21:20
  part one of the vascular training series. A sincere
• 21:23
  thank you to Professor Ibora and Professor Konczar
• 21:26
  for sharing their experience, perspectives and
• 21:28
  values that guide their approach to teaching.
• 21:31
  In part two, we'll continue this conversation
• 21:33
  from trainees' perspective, exploring how young
• 21:36
  vascular surgeons across Europe see the current
• 21:39
  training landscape and what they believe could
• 21:41
  help shape its future. Thank you for listening
• 21:44
  to the ESVS podcast and let's hear final thoughts
• 21:47
  from our guests. The key point is to have a strong
• 21:50
  mentorship. So we need trainees, we need trainers.
• 21:53
  Everybody has to dedicate to education. We have
• 21:57
  to work on the trainees, but as well on the trainers.
• 22:00
  Thank you.