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Newsletter August 2020: my TEP experience

Margarita Borislavova

drborislavova.m@gmail.com

 

I am a final year resident in anesthesiology and intensive care at Tokuda Hospital Acibadem City Clinic in  Sofia, Bulgaria. After several years of applying for the ESA exchange program, I got a positive answer in November 2018 and I was thrilled.

 

Why this program/why this centre?

Within the last 2 years of my residency, I have come to see how important programs of this scale are. Theoretically, we all know how crucial the exchange of knowledge, best practices and international collaboration are for the development of our clinical and critical thinking.

But experiencing it in practice is completely different, both eye- and mind-opening. If we want to accomplish better patient care, safety and outcomes – then international networking and brainstorming with leading experts is an absolute must. Before, I had felt that thanks to ESAs live-sessions, seminars and congresses, and now I have had the chance to live it for two months in IKEM hospital, Prague, the Czech Republic.

My reasons to choose this centre was my interest in the anaesthetic management of patients on haemodynamic support devices, high-risk patients with of end-stage heart failure, heart transplantation and along with that learning, basic echocardiography as all this is quite limited in my country. After a thorough search between the available centres I chose IKEM because it was combining everything I was looking for – it is the biggest heart centre in the Czech Republic performing around 50 transplantations a year and dealing every day with challenging patients on different assist devices, with highly qualified cardiac surgery anaesthesiologists, certified in TEE as well. Furthermore, it is a centre with international collaboration for example with France, Denmark which allowed me to gain even more international experience and expertise and to make new connections and friends.

 

Do expectations meet reality?

My mentor and coordinator in Prague were Dr Riha and from the first meeting, we had when I visited the centre for the first time (another great component of this program – one is able to visit the hospital in advance) I felt sure I had made the right choice.

Starting my fellowship in November, I was welcomed by all the team. Most of the staff speak very good English, so communication was not an issue.

Together with Dr Riha, based upon my expectations and professional goals for those months, we made a plan for each week. Coordination and organisation were extremely easy – simple but important things like a security batch, a locker and identity card were already waiting for me the first day.

During my exchange, I was involved in everyday clinical work both in the ICU and the OR depending on the variety of operations and cases (sometimes it was difficult to choose as there were a lot of interesting procedures going on at the same time – an ordinary day in the OR consists of for example – aortic dissection with arch involvement, transplantation, and total artificial heart placement happening in theatres next to each other).

 

What did I learn?

  • anaesthetic management for patients on and for different mechanical support devices – IMPELA, HeartMate3 and BIVAD and Total artificial heart
  • different anaesthetic modalities for intraoperative management of advanced and acute heart failure – mechanical but as well pharmacological!
  • ECMO in different settings and modulations. I became aware of the local protocols for the initiation, monitoring and weaning from ECMO
  • I got the opportunity to observe several heart transplantations and complicated cardiac surgery – aortic dissection with circulatory arrest, combined valvular procedures in the setting of acute infectious myocarditis
  • I got the chance to see some rare cases which have enriched my medical background – like giant cell myocarditis in a young patient with strong immunisation
  • I gained basic knowledge in TEE and TTE by learning from some of the best-certified ana Dr Riha also provided me with open access to their new interactive echo -lab and online library ( it was vital for me as I struggled with 3D imagination of echo-images! )
  • the hospital has open access to several international journals so one could freely browse the latest publications.
  • As if this was not enough, I was made to feel welcome as a part of the team by participating in their Christmas party and out hospital meetings. That levelled up the whole experience as one gets to feel the local culture and spirit. Prague is an amazing city with a rich culture, kind people, great history and food…it is inevitable to fall in love with it.
  • And what was the most important thing I learned from this program is that knowledge should be perceived as ENERGY- and like it, it should not be lost. It is here to be transferred and shared.

 

Coming back home, now I am able to approach clinical situations in a different way and I feel empowered to fight for new protocols and devices, as I have already more expertise in the field. For the moment in my country trainees are not educated in basic echo, which is still considered to be a cardiologist’s task. But happily things are changing, and I will be able to apply my new competence in every – day practice and share it with my colleagues.

 

The bottom line

I am extremely grateful to have made this professional journey. It has definitely enriched me not only on a professional but also on a personal level. That is why I strongly recommend to everybody to try and search for programs like this one.

I want to thank ESA for providing this and many other opportunities for continuous education and for investing in young clinicians. I appreciate the time and energy that my local coordinators (Alex Rawlings, Els Sung and Dr Riha) have invested in the process. I want to express my deep admiration to all the health-care professionals with whom I have worked – for their devotion to teach and share their experience, for their encouragement and kindness. Thank you for inspiring me to be a better clinician.

 

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