The grants offered by the Practicum Foundation through FAC are the best international display

“I completed my residency at the Emergency Hospital Dr. Clemente Álvarez, and after that, I trained at the National Atomic Energy Commission to join the Nuclear Medicine specialty, and today, I divide my time between Clinical and Nuclear Cardiology and teaching. Furthermore, I participate in the new cardio-oncology committee of FAC.” This is the introduction letter from María Candela Vivas, a recognized Argentine cardiologist with eighteen years of experience. We talked with her to learn her impressions about Practicum Script.

Madrid, June 14, 2018. We know that medical error is the third leading cause of death in the United States and that it is often due not only to knowledge gaps but also to flaws in clinical reasoning. Do you think it is necessary to move away from the traditional formats?
Practicum Script is an interactive course that exercises diagnostic speed and certainty. Personally, I'm interested in the challenges and the new tools. I feel drawn to the need for a quick response, as we often find situations that need to be resolved and without time to obtain a second opinion.

Can you mention any cases that have been of particular interest to you? 
I could name many, some because they are not what I usually see in my clinic, and others because they force me to review actions. Perhaps because of professional defect or addiction, what mostly motivated me to shake my neurons were the congenital heart diseases, and probably also the valvular heart diseases. On the other hand, today, precisely, the time is short and the interesting fact about this course is its flexibility, which allows one to adapt to their personal availability. I believe that resolving each case takes no more than 15 minutes.

Of all the assets we offer during the course, what is your favorite as a learning resource? Do you miss something?
The portfolio, the update summaries, and the attached quotation are especially helpful to me. With regard to weaknesses, there may be some inconvenience in accessing some drugs that are not available in our country and are common in Europe. On the other hand, I recognize that it was hard for me to be encouraged to question the tutor about some points, but once I understood the system, disagreements in diagnosis and treatment were accepted mostly without problems. Maybe due to differences in vocabulary.

Medicine is not an absolute science. What contributes to an approach to the complexity, disagreement, and controversy phenomena in medical practice?
I am pleased to work in an institution where cases are routinely discussed, and we allow for disagreements and accept criticism of our own management. Contributions always work because one nourishes from these differences, and when things go well, one feels comforted. The same is true for Script’s cases. It is good to see when one overcomes goals.

You have been the residents’ teaching coordinator at the Dr. González Sabathié Institute of Cardiology since 2013. What is your opinion about the use of Practicum Script in continuous training?
My training had an abundance of clinical reasoning and, at the same time, the technological shortcomings of a public hospital. I believe that complementary tests should not transform us into mere technology dependents. I insist on clinical training with my residents, as access to new equipment might not be available in the places that they will join once they finish residency.

In the field of medical education, where should we place the focus of attention?
There is a change in the way education is delivered, and it is necessary to adapt permanently to that. Young individuals use a lot of technology; they love to train without having to waste time moving from their own notebooks, and I recognize that this is also appealing to me. I also believe that there is a lot of supply and sometimes it is not easy to select the most appropriate strategy when someone searches for training, this should be done in places of reference. But we should not lose our focus, which is the patient, with all the set of situations surrounding them and the interaction with them.

Do you notice differences in the exercise of your profession in the province of Santa Fé in relation to Buenos Aires? Could you classify the simulation with PS regarding this context?
There is a saying that we have here that goes like this: “our city is a big village.” I believe our city is a place where social problems and economic fluctuations are felt perhaps more than in Buenos Aires, the treatment is more personalized as in rural areas of the country and one gets more involved with the problems. We have a large industrial belt around us, and the countryside is only 30 minutes away, so the patients who come to us have different realities. The simulators present real cases with patients who, for different reasons, abandon treatment or do not follow recommendations, something that we see in our daily practice.

This year (2018), you became a member of the cardio-oncological committee of the Argentine Federation of Cardiology (FAC). In what line do you currently work on?
This is a very recent committee, which was formally created during the last FAC congress. The idea at the moment is to try to exchange information, generate multidisciplinary groups, and train colleagues with less access to training, maintaining a spirit of collaboration with distant centers with less access to technology.

What were the main conclusions of the FAC congress that was recently held?
I believe that the backbone has been prevention. We were able to receive information from more than 40 colleagues from the US and Europe, with new strategies and insights on technologies and therapeutic approaches. We exchanged opinions, and international agreements were strengthened. All committees participated with the same interest in the prevention of different lines of work.

You’ll get to know the federation's agreement with the Practicum Foundation. What is your opinion about this international collaboration structure?
For us, countries in development, it is of great benefit to have agreements of this nature (referring to the scholarship grants that the Practicum Foundation grants to FAC under a mutual academic sponsorship agreement). Through the FAC, the connections for our training are facilitated. For the professionals, this is very expensive, since no institution – public or private –pays for the access to training and would be impossible to do it independently. In addition, these grants that Practicum offers through FAC are the best international display of the foundation.

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