“...and where would I hear the murmur?” – Anonymous participant at a recent Championing Care meeting

All of us, having alternately taught and been taught all of our lives, are educators, reveling in that never-ending cycle of falling behind and catching up again, reproduced the world over.

Tactically, our post-graduate continuing medical education has been structured as “onion-skinning,” our substantial pre-existing knowledge base repetitively veneered with a thin layer of highly specific new content applied intermittently. In practical terms, a group of interventionists come together and receive late-breaking information about interventional cardiology,  echocardiographers gaining similar information regarding their imaging modality, that content being tailored specifically to what is a highly select audience, a horizontally homogenous group consuming specific information updates in a periodic fashion.

In the pilot Championing Care pilot project, the ACC has shifted that paradigm to one of a vertical education process, a specific disease rather than the providers level of training being the focus, euphemistically “cutting the onion in half” of educating a very heterogeneous group whose pre-existing knowledge base is far from uniform.

In this pilot initiative, our quarternary transcatheter aortic valve replacement (TAVR) centers of excellence, the large group of general cardiologists who refer to those TAVR centers and that even larger group of primary care physicians who refer to the general cardiologist are receiving similar education around aortic valve stenosis evaluation and treatment. Having recently participated in one such event, it became very clear the Herculean nature of the undertaking. Analogous to “as low as reasonably achievable” in our radiation exposure training, it is apparent that the understanding of a disease such as aortic stenosis falls off by the fourth power of the radius as you move away from the centers of excellence.

This is not a criticism of our general cardiologists (and I am one of those)  nor our primary care colleagues, but rather a stark wake up call to the fact that our continuing education system is in need of improvement, not just in techniques of delivery but in fundamental ways that challenge our notions of education itself.

How much of the “slow penetration” of new information into the medical community is due to our failure to educate vertically into the primary base of caregivers, our failure to facilitate an understanding of the disease and its management among those on the front lines, a failure to foster a cooperative relationship among caregivers?

Imagine the potential  impact of such targeted disease specific efforts around anticoagulation in atrial fibrillation, chronic systolic heart failure care, or coronary artery disease management. What would be the effect of such programs on inappropriate imaging and outmoded, ineffective therapies?  How would we define “team care” in such an environment?

Perhaps we are witness to a game changing shift in continuing education strategy, perhaps not. But it certainly is fun to learn.

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