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3rd Aortic Live Symposium
Aortic surgery education –Germany
D.-S. Dohle, MD
Department of Thoracic and Cardiovascular Surgery, West German Heart Center,
University of Duisburg-Essen, Germany
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Disclosure
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Speaker name:
Daniel-Sebastian Dohle
I have the following potential conflicts of interest to report:
Consulting
Employment in industry
Stockholder of a healthcare company
Owner of a healthcare company
Other(s)
I do not have any potential conflict of interest
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Structure
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The governmental perspective:
o Medical Continuing Training in Germany
The medical society perspective:
o The Curriculum 6+ of the GSTCVS
The personal perspective:
o Elements of aortic surgery education
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The Governmental perspective
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Basic medicaltraining
o minimum 6 years, incl. 48 weeks practical training
o State examination
“Approbation” = License to practice medicine
ContinuingTraining
o Surgery: minimum 6 years, 24 + 48 month
o Training curriculum “Musterweiterbildungsordnug”
o Examination by federal medical board
Specialist for Surgery:o General / Vascular / Cardiac / Thorax / Orthopaedic / Plastic / Visceral
ContinuingTraining
o Specialities and Extra Qualifications
o Certified by medical societies
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The Governmental perspective
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The German Training curriculum of all disciplines scanned for ”Aorta”Exemplary for the Federal state North Rhine-Westphalia
In total 9 hitso 3 about paraaortal
Lymphadenectomy(Gyn)
o 3 Vascular surgeryo 3 Cardiac surgery
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The Governmental perspective
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The German Training curriculum of all disciplines scanned for ”Aorta”Exemplary for the Federal state North Rhine-Westphalia
VascularSurgery
CardiacSurgery
Reconstructive Operations:• Supraaortiv vessel: 25• Aortic iliac, visceral,
thoracic vessels: 50
Operation ± ECC:
• Aortic valve + • Ascending Aorta /
Mitral / CABG: 25
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The medical society perspective
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The “Curriculum 6+” of the GSTCVS and its Young Chapter
[1] S. Günther et al. “Modulares Curriculum 6+,” Z Herz- Thorax- Gefäßchir, vol. 30, no. 1, pp. 2–5, 2016.
Basic-modules 1. Basics in Cardiac Surgery I2. Basics in Cardiac Surgery II 3. Coronary artery disease I4. Acquired Aortic valve diseases I5. Acquired AV-valve diseases I6. Thoracic aorta diseases
refresher-modules 7. Exam review course (theory)8. Exam review course (Skills Assessment Lab)
special Modules 9. Perioperative Echocardiography10. Pacemaker-/ ICD- and CRT-Therapy (I-III)11. Congenital cardiac anomaly (I-II)12. Coronary artery disease II13. Acquired Aortic valve diseases II:14. Acquired AV-valve diseases II15. Thoracic organ transplantation16. Cardiac assist systems and artificial heart
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The medical society perspective
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Basics in Cardiac Surgery I
Target audience: first year residents
Content: Patient and peripheral ward management, basic surgical skills
Basics in Cardiac Surgery II
Target audience : second year residents
Content: cardiac surgery ICU management, ventilation, dialysis, ECMO, ECLS, ECC
Coronary artery disease I
Target audience : residents
Content: Patophysiology, Indications, revascularisationstrategies, wetlab
Acquired AV-valve diseases I
Target audience : residents
Content: Patophysiology, Indications, operative techniques, wetlab
Acquired Aortic valve diseases I
Target audience : residents
Content: Patophysiology, Indications, operative techniques, wetlab
Thoracic aorta diseases
Target audience : residents
Content: Patophysiology, Indications, operative techniques, interventional strategies, wetlab
The “Curriculum 6+” basic modules
[1] S. Günther et al. “Modulares Curriculum 6+,” Z Herz- Thorax- Gefäßchir, vol. 30, no. 1, pp. 2–5, 2016.
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The medical society perspective
9[1] A. Beckmann, et al. “German Heart Surgery Report 2015: The Annual Updated Registry of the German Society
for Thoracic and Cardiovascular Surgery,” Thorac Cardiovasc Surg, vol. 64, no. 6, pp. 462–474, Sep. 2016.
German Heart Surgery Report 2015
+ 549 abdominal procedures and 609 endovascular abdominal stents
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The personal perspective
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Elements of aortic surgery education in Germany
CardiacSurgery
Imagingskills
clinicalskills
ICU
wireskills
Aorticconsultation
hours
Hybrid OR
RadiologyScientificprogram
operativeskills
patientcontact
Knowledge Experience
mentorship
continuous effort + time + exposition
AORTIC SURGEON
Responsibility
Theoreticalknowledge
Strategic experience
Network
VascularSurgery
cardiovascular center + infrastructure
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The personal perspective
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limitations in aortic surgery education in Germany
o Max. 8h a day / 48h a week by law:
o Many cases during night: Education during night
limits manpower during day
o Complexity of cases
Continuous, intrinsic motivated personal effort
Structured curriculum, specialist for aortic surgery?
For both: trainee and mentor
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