Education in Phlebology: Getting Beyond the Basics

Many times education and learning involve doing things we’ve never done. Sometimes even doing things we don’t want to do. Yet we trust those who have experience and believe that when we are done with the education experience, it will be for our benefit and our patients benefit. Those of us involved with phlebology come from diverse backgrounds. Our foundations of skills are different but we all hope to achieve the main goal of being able to manage problems in a cohesive and somewhat similar manner.

This monthly series of articles will touch on the many various routes and opportunities available to get to where we all want to be: competent phlebologists.

Medical/surgical training traditionally has been a glorified apprenticeship. You learn by observing and being taught by those who already have some experience. They know a lot but they don’t know everything. They teach you what they know. But with every teaching cycle there are students who ultimately surpass their teachers. Those students elevate us to the next level.

“Just take this big clamp and place it on the aorta. Then close it and stop the blood flow to the lower half of the patient’s body”. Does this sound logical or reasonable? Of course not, but this is what your teachers (vascular surgeons) tell you to do when you do an open aortic aneurysm resection. As crazy as it seems, it usually works. The point is: you’re not the first one to do this. You may feel uncomfortable doing this, but you do it because the person teaching you has told you its ok. Education and learning involves a leap of faith at times.

When first starting a “vein practice” there are so many things to consider. At times, feeling comfortable with feeling uncomfortable will be your best asset. Training and education involves this concept. If you can’t be comfortable doing something you’ve never done before then you may never get beyond the basics. Education is a process that takes you from a safety zone to an uncertain zone and back to a new safety zone. It is up to your teachers to make you as comfortable with a new procedure or new technique as you can be. But until you’ve done a few on your own, a certain anxiety level will be there. That’s okay. How to minimize the uncomfortable feeling is what we hope to explore over the next few months. Getting comfortable with feeling uncomfortable.

As an example, we started The Annual Fellows Course in Venous Disease two years ago to fill a void in vascular fellowship training. Most vascular fellows get a large experience with arterial disease and arterial endovascular procedures. A few training programs highlight venous disease, most do not. This statement could probably be applied to most training programs: medical, surgical, interventional radiology, dermatology etc. We felt a two and one half day course specifically directed towards the unique needs and open attitude of vascular fellows would be beneficial. This is an industry-sponsored event with all fellows expenses covered. The attendees are limited to 35 fellows and eight faculty members. All aspects of vein disease are covered. The course is interactive and responsive to the fellows needs such as; core knowledge, technical expertise, practice development etc. For them learning new techniques and concepts is a natural extension of their training. They are the easiest to educate because they hold minimal pre-conceived ideas. For many reasons the course has been well received and successful. The courses for 2008 will be held at Englewood Hospital and Medical Center in New Jersey and at the Cleveland Clinic in Ohio. Early education is key to specialty growth and well-trained specialists.

The other end of the spectrum is teaching new ideas to physicians who have been in practice. For the past seven years, I have participated as faculty or director of many types of educational programs attended by physicians interested in venous disease. Most of the attendees have some pre-conceived notions of vein disease management. In the beginning many felt the newer minimally invasive procedures wouldn’t ever work. The academics, in general, were the most skeptical.

My attitude is to always adopt the concept: “Respect the Elders, Embrace the New, Encourage the Improbable and Impractical, Without Bias.” How else can we ever progress if we think what is the best is what is? So as open as young physicians are, experienced physicians tend to want to stay in their comfort zone and do what they know. It is much harder to get practicing physicians to be “early adapters” of new techniques or technologies. Many physicians need to be shown long-term data regarding efficacy and safety.

Phlebology is in a state of flux. There are many courses addressing the needs of practicing physicians to obtain sufficient core knowledge. Once we reach the tipping point of having enough people educated, it will become a more self-propagating specialty. Long term the goal is to make courses such as the Fellows Course in Venous Disease obsolete. Knowledge about venous disease will be incorporated into the training programs of those specialists that see patients with vein disease. It is up to the various professional organizations and interested industry to begin a process to achieve the goal of comprehensive venous training. Some have already such as the American College of Phlebology, which has inaugurated a fellowship in 2007. All involved will need to get comfortable with feeling uncomfortable.