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Henry Oluwasefunmi Savage MRCP

Event News, News & Views

‘Teach Me To Pace’ -The Dilemma Of The Cardiology Registrar: Dr Henry Savage Reports

Tolochenaz is a small industrial town 30 minutes from Lausanne in southern Switzerland. It is also home to the Europe headquarters of Medtronic.

Here every year, about 60 cardiology registrars at various levels are put through a 2 day knowledge and hands on workshop on Bradycardia and Pacing. Completely funded by Medtronic, including flights and accommodation, it serves an introductory level to basic Bradycardia pacing and programming.

Pacing like many other skills in cardiology requires ongoing hands on experience in order to achieve any sort of competence. It also requires a fair amount of dedication to acquiring the background knowledge that is necessary to act as the foundation blocks. The same can be said of programming but you could argue that more knowledge than skill is required.

Currently there is no formal training arrangement for registrars in the UK that can give you this experience. Interviews with a number of registrars at various levels suggests that they have acquired a lot of their current skill and knowledge by the traditional ‘osmosis’ method from bosses and the like. Many perform their procedures based on what they have seen some else do, and you can sometimes get these operators struggling to explain the rationale behind every twist and turn of catheter or sheath.

According to the JRCPTB’s current training curriculum for Cardiology registrars, their aim is, ….to develop both the generic and specialty specific attributes necessary to practice independently as a consultant cardiologist, and to train individuals to provide the highest standard of service to patients who have cardiovascular disorders which includes development of knowledge and skills necessary to mete out this service’


Dr Mark Hall, shown centre photo bottom row

Mark Hall, consultant cardiologist at the Liverpool Heart and Chest Hospital started this ‘Introduction to Pacing for SpR’s ‘ course, in conjunction with Medtronic in 2006. Since then over 250 Cardiology trainees have been put through this programme. The stimulus for generating a program like this was according to Mark,’… a final year registrar I felt there was a big training gap especially with regards pacing amongst my colleague and juniors.  No one seemed to be giving any training but we were all expected to understand pacing automatically’. ‘As one of the largest manufacturers of cardiac devices in the world, I contacted Medtronic to help design a course that would be beneficial to all comers’.

Asked what the structure of the course he intended was and he replies, ‘The idea was to create a program that would explain the basic concept of operation of pacemakers as well as provide hands on experience at lead implantation and the surgical skills required. We also aimed to stimulate interest in Electrophysiology and use of devices for trainees who may not have chosen a career path.’

The 2 day course includes a series of lectures, basic programming in a Virtual outpatient pacing clinic, a surgical implantation skills station using Pork bellies or the like as well as the use of a state of the art Virtual catheter Laboratory where training with ‘Fluoroscopy’ assisted Lead implantation takes place. All this training is delivered by a faculty which includes very experienced cardiac physiologists and about 15-20 consultant cardiologist across the UK. At the end of the 2 days, you certainly feel like you have been infused with a huge dose of knowledge and an experience that can only make you confident at your next case. One of the trainees at the course remarked;’…why isn’t this a compulsory requirement for any cardiology registrar before they are let loose on patients?’  Good question? I feel that you should be familiar with any sort of treatment or technology that you prescribe to patients. Unfortunately the way the cardiology training program is designed, you are literally constantly ‘smashing and grabbing’ in order to obtain any sort of decent experience.

A lot of trainees are more focused on getting those numbers up for the RITA’s, or towards their CCT’s than they are on learning to perform their skills properly. Who is to blame? Well I’m not sure actually. In fact I doubt that this is a blame game. How do you provide a system where you are able to provide a high level of training effectively and consistently across board to a group of people? It is certainly a budget that cannot be handled by the JRCPTB and our contributions to training.  With the focus on pacing and this excellent course by Medtronic, one would argue that you can extrapolate this to other skills training.

But, is this sort of organized and formal training necessary? To that I answer yes, because everyone should feel confident about whatever skills they will be required to use in their daily practice. The only way to achieve this is to be trained appropriately. It is clear that junior doctors cannot afford expensive training courses on a continuous basis, otherwise along with all the other fees we all pay; we’d probably end up living on the streets. The government needs to step up to be counted, as if the NHS wants high quality doctors who are skilled in their specialty, then we all have to make a contribution towards this training.

I feel privileged that I was able to attend a course like this. I genuinely feel like I have been empowered to actually effectively discharge a skill based on the very clear background knowledge provided to me. This complements quite nicely, whatever live training experience I have been and will be exposed to. Of course skills’ training is a continuous process which you cannot completely learn in one sitting, but this course certainly provides a high quality, introductory level entry point into basic pacing, implantation and programming that is highly recommended for not just any one interested in pacing and devices, but everyone who is a cardiologist and who as part of their training must have some knowledge of pacing. My advice, get in now while it’s still available.

To register to for the course, you have to contact your local Medtronic representative who will register your interest and put you on the waiting list. Unfortunately to ensure the quality of hands on training at the course is at a high standard, Medtronic can only cater for small numbers on each course.


The views expressed in this article are solely that of the author. They do not represent ideas of Medtronic, any such companies or other individuals. There are no competing interests to declare.

Photography by : HOSavage, SAVO Creative Photofactory

Published on: April 20, 2010

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