Too good but not good enough: Training caught in transition

✍ Scribed by Joseph D. Babb

• Publisher: John Wiley and Sons
• Year: 2002
• Tongue: English
• Weight: 47 KB
• Volume: 55
• Category: Article
• ISSN: 1522-1946
• DOI: 10.1002/ccd.10212

✦ Synopsis

Recently a laboratory experienced an unusual complication during a catheterization procedure with catastrophic results and an ultimately fatal outcome. The operators were stunned by this unexpected development. Although they correctly diagnosed the problem, they had never seen this problem before and were unsure about the full range of possible responses to the crisis. They performed well and stayed calm, but in the aftermath they were clearly troubled by the fact that neither of them, both experienced operators, had ever seen this problem nor had to deal with it before.

This led to some reflection by me. The historical approach of "see one, do one, teach one" has given way in our era of complex and technically challenging procedures to a more prolonged and codified training experience. Internal medicine has grown from two years of training to three years, cardiology from two to three years, and interventional cardiology adds another one to two years. Twenty years ago one could practice a full range of invasive cardiology procedures, as they were then available, after four years of post-doctoral training (two IM and two cardiology). That same level of practice now requires at least seven years.

This reflects expanded knowledge of disease mechanisms, more comprehensive avenues of disease manage-