Who’s Responsible for EP Fellows’ Education in 2010? March 10, 2010

 In theory, the social contract of medical education is straightforward: trainees exchange years of their lives and earning power for the opportunity to be taught increasingly esoteric skills by their field’s established practitioners. But, as in every highly-evolved, complex ecosystem, individual organisms strive to find ways to obtain what they want with the least expenditure of energy.

 What do I mean?

Although I was in grade school at the time, I have been told that EP training once consisted of learning from paper tracings generated during studies performed at your institution. These were reviewed with your mentor and the salient points were identified, clarified and distilled into the essential elements needed to become a fully-fledged EP. Every necessary educational resource was present in your institution: patients, equipment, didactic sessions and procedural opportunities. Perhaps in some institutions this is still the case, but it is certainly not that way everywhere.

I talk to a lot of EP fellows. We talk about the good and bad of our training experiences, the differences from one institution to the next and how we were or were not prepared for the real world. Despite being from all over the U.S., and regardless of whether we trained at a renowned academic institution or a clinically oriented one, many of us have similar misgivings about our training. Foremost among these is the decline in teaching “fundamental EP.” What is this? A thorough understanding of physiology, the ability to interpret electrograms, formulate a working hypothesis of a clinical arrhythmia and test that hypothesis with a battery of pacing maneuvers. These are still the essential elements of cardiac electrophysiology. (more…)