TCT: Improving clinical skills key to interventionalists' success

MIAMI—Cardiologists who want to become leaders in their field should focus on expanding skill sets that enable them to competently perform procedures rather than learning new procedures, Paul Sorajja, MD, said Oct. 23 at the Transcatheter Cardiovascular Therapeutics (TCT) conference. By doing so the physician is positioned to learn all new techniques of interest and importance to his or her practice.

Sorajja, of the Mayo Clinic in Rochester, Minn., emphasized at a panel on launching and sustaining a career that being a competent practitioner requires a commitment to life-long learning and willingness to continuously improve. But improvement mainly occurs through practice and experience, and gaining the necessary practice and experience can be a challenge for interventional cardiologists,  especially those specializing in treating structural heart disease.

Sorajja explained that the complexity of cases that may be amenable to intervention is constantly increasing, so the interventional cardiologist often faces a patient with a set of conditions or circumstances that the physician has not dealt with before. Also, the specialty is evolving quickly; there is a continuous flow of new data and new theories. For structural heart disease specialists, there are no established competencies, no certifying boards or other standard makers. Cardiologists may see a low volume of patients with very complex disease; competing specialties may siphon off some of the interventional cardiologists' pool of patients.

But those factors need not stop a physician who is committed to learn. "When the current SCAI [Society for Cardiovascular Angiography and Interventions] leadership did their fellowships, most of the common procedures we do every day weren't developed yet," he noted. Today's interventional cardiology leaders acquired the skills they currently use in their practices through post-fellowship training and experience.

Sorajja asserted that interventional cardiologists who wish to expand the universe of procedures they perform competently can best do so by developing transferable skills. He said that mentoring for those skills is available within most facilities.

For example, Sorajja said that he approached electrophysiologists for help when he wanted to become more comfortable working in the left atrium. Specialists in congenital heart defects can be mentors for device closure techniques, and vascular surgeons for pre-closure techniques. Interventional radiologists can teach snaring and retrieval.

If a physician has the technical skills and clinical expertise, he or she can become an early adopter of emerging techniques, Sarojja said.  Once colleagues recognize a physician with an admirable skill set, industry tends to seek that physician out, providing more opportunities for the physician to work with new devices and techniques.