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It is very hard to say 'I do not know;' to exercise thinking skills is to help horizontal reasoning

DR. JUAN PABLO ESCALANTE 

Head of the Cardiac Insufficiency Service of the Cardiovascular Institute of Rosario, Santa Fe (Argentina)

The 35-year-old Argentine Juan Pablo Escalante has been a physician since 2008 and has spent four years teaching residents. He is specialized in heart failure (HF) and transplant and pulmonary hypertension (HP), and is a former member of the Heart Institute in São Paulo (Brazil) and Cedars-Sinai in Los Angeles (USA). Upon his return from abroad, he participated in a prominent transplant in Argentina. Currently, he directs the HF service of the Cardiovascular Institute of Rosario and serves in the HF and HP Committee of the Argentine Federation of Cardiology. He sees Practicum Script as “an innovative way to learn, making it more real and applicable.”

Madrid, February 15, 2018. According to the WHO, countries with higher incomes are reversing the trend of cardiovascular diseases as the leading causes of mortality, and by 2025, a 25% decrease is expected in premature deaths due to these types of diseases. In less developed countries, this trend is toward an increase. What side does Argentina lean to?

I think Argentina is on a very good road. The professionals in our country are highly educated, and the Argentine scientific societies (the Argentine Federation of Cardiology and the Argentine Society of Cardiology) collaborate to ensure that this is maintained.

I practice in a third-level, private healthcare center, where these indicators have been improving with hard work. Even the communication between the institution’s emergency services and personnel has improved substantially, resulting in a short time between the appointment and delivery of the adequate treatment for each pathology.

Perhaps you agree with us that no knowledge fulfills its objective if it is not available and accessible to improve people’s quality of life. What is the value of a virtual athenaeum like Practicum Script?

[Practicum Script] is an innovative way to learn, making it more real and applicable. It simulates daily work, and no other experience has previously fulfilled this task. I coordinate a cardiology ward, in which we discuss diagnostic and therapeutic hypotheses every day, and the decisions vary according to the results. This simulator is very similar to real life and daily work.

Beyond traditional rote learning, do you consider necessary to be able to make mistakes without consequences, thanks to controlled simulation environments?

[It is] fundamental. I consider error to be part of learning. It is safer to err in a simulation.

Knowing that controversy and uncertainty are the bases of our approach, what has been the most difficult and/or controversial case that you have faced?

A patient with pulmonary hypertension who had elevated pulmonary capillary pressure and normal left [heart] chambers. It was a great diagnostic challenge.

In English, we are told to think outside the box, but the truth is that we tend to look for predesigned solutions, which is one of the main causes of error. Why should thinking skills be exercised in medicine?

One often tries to find explanations to a problem and, when meeting difficulties, end up looking for easy or prepackaged approaches. It is very hard for our wisdom to say "I do not know," or to be unable to find the answer to a problem; this is even worse when doctors do not work as a team, as often happens. To exercise thinking skills is to help horizontal reasoning, in which you tend to look for other explanations or solutions.

It’s been half a century since the first heart transplant in Argentina. How is the situation now? What do you remember about the terminal case of Juan José Argentieri from Rosario?

I remember everything about this patient, absolutely everything. This was my first transplant after returning to Argentina (from Brazil and from a short stay in the US) to our program. It was a great challenge that proved to be successful.

Regarding the situation of transplants, it has been stable for years. Every day, new tools emerge to carry them out, from ventricular assist devices to donor preservation techniques. Transplantation depends on substantial effort from many people, from the place where [the organ] is preserved to the one where it is transplanted. In this aspect, the Central National Institute for the Coordination of Ablation and Implant works very well, providing constant support and brilliant coordination to allow transplants to happen.

Testimonies

For me, the program is very interesting, since it allows me to sharpen my interrogation and direct it more towards a specific pathology and to have more knowledge of laboratory and cabinet exams. I think it is very important that we keep our medical sagacity throughout our practice and that in the few minutes it takes to answer any of the cases that Practicum Script presents, you acquire more knowledge.

Dr. Miguel Olivares Alcocer

Pediatrician in Guanajuato (Mexico)

I would like to express my gratitude to the Practicum Institute of Health Sciences Research for the opportunity given to Latin American physicians  to access and take different courses of our specialty for the benefit of our dear patients, in my case in Mexico. It has encouraged me to improve myself and keep abreast of the advances in Pediatrics and put into practice the knowledge acquired in the hospital where I work. Thanks friends and congratulations to this valuable team of Practicum Script Education.

Dr. Heriberto Fuentes García

Pediatrician in Sonora (Mexico)

I am grateful for this study tool that, through Nestlé and with this method, allows us to review different issues with cases that confront us in decision-making and serve us in the daily consultation.

Dr. Josué Refugio de León Padilla

Pediatrician in Jalisco (Mexico)

It is an excellent educational support platform for the pediatrician, offers very specific clinical challenges with alternatives for diagnosis and differential diagnoses, with the support of experts, a bibliography and a forum to share opinions. It's easy to navigate and it's fun, a tool that's worth using and making the most of it.

Dr. Guillermo Yanowsky-Reyes

Surgery Pediatrician in Guadalajara (Mexico)
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