A realignment for the Basic Science Task Force

Why we’ve realigned the Basic Science Task Force

Patrick Myers Domain Chair, Acquired Cardiac Disease

It has been a privilege to have Jan Ankersmit from the Medical University in Vienna to chair the Basic Science Task Force for some time now. He’s done a phenomenal job but had too many responsibilities at his home institution to continue chairing this task force. With Jan’s departure we took the opportunity to look again at the Basic Science Task Force and recruited a group of diverse clinicians and scientists involved in basic research to join. We also asked Juan Grau, Director of Cardiothoracic Surgery at The Valley Heart and Vascular Institute in the US, to chair it. Among the initiatives that we have considered is a different way of integrating basic science with all the other areas that EACTS covers. For example, at the Annual Meeting each task force would usually develop its own focus and abstract sessions, and that would be the same for basic science. Although basic science can be very interesting for practising clinical surgeons, it’s often not hugely relevant to their practice and perhaps not as interesting to them as other content that they are able to engage with at the Annual Meeting. So that was something we had to think about – a lot of work goes into those basic science session, so how do we generate more interest? Linked to this, we have been seeing that the basic science that underpins interventional procedures such as TAVI and so on is crucial – the basic science of the valves and the bio engineering is vital to the development of new devices and treatments, and therefore important to the future of both specialties. As a result, we have been working hard with Juan Grau to re-energise the approach to basic science. The outcome is that we have now basic science sessions at this year’s Annual Meeting that are integrated into the wider scientific programme. For example, a session on transcatheter valves will also look at the basic science of the valves and their application, what we know about them and what can we expect from them. We have seen that our colleagues from cardiology are increasingly interested in this sort of approach and I think that many other EACTS members will also welcome it. Having taken this big step to integrate it with the wider programme, I feel basic science will now become much more visible and much more approachable to the practising surgeon, whatever their speciality.

Juan Grau, Chair, Basic Science Task Force

What does basic sciences do for cardiothoracic surgery? In general, I would summarise it as the following: it brings objectivity. The experimental method does not have a personality, it doesn’t have an agenda. Either things work or they don’t work. Your experiments are going to tell you whether you were correct in assuming that this is the mechanism or technique you thought it would be. Given the world that we live in today, that objectivity is crucial. As a scientist and as a surgeon, clinical medicine is very clear. You do an operation, everything works well, and the patient walks out of hospital in better shape. Now how can you improve that? How can you make it less invasive, how can you make it more effective, how can you make it more streamlined? For that you will have to use the tools of basic science, meaning you will have to create an experiment, devise a method, test it, validate it and then implement it. These fundamental tenets of research and investigations are in general very healthy. It is a healthy reminder for all us clinicians to see and understand the bar that we have to meet. And we do have to meet that bar, and even exceed it, if we want our breakthrough interventions to become mainstream. This is why we need to keep analysing the information and the science. Lately we have had significant issues with major clinical trials where the results were somewhat confusing or debatable. This happened because the statistical methods changed or some of the definitions were altered during the course of the trial. In the light of that, what an understanding of not only basic research but also statistical methodology gives you is the ability to be analytical and to have good judgement about the information that is being fed to you and what it is telling you. So that is how I would describe basic science. It brings objectivity to medicine, which can sometimes feel as much of an art as a science, and it tells us what is really happening and why. For me, this happens regularly. I can send specimens sent to my PhD students that I believe are putting us on the perfect path. But then they come back and tell me the specimens are not good enough. That is the beginning of objectivity, because you think you’re going to obtain particular results about particular issues and then you are told otherwise. How many other areas of life can deliver that level of objectivity, telling you with certainty that something is wrong or not good enough and needs to be better? This is what my PhD students do regularly, they practise basic science, and it keeps me very grounded.

PASSING THE COVID TEST

The European Board of Cardiothoracic Surgery faced big challenges in delivering professional exams during the pandemic. In October last year the Level 1 exams were divided for the first time into cardiac and thoracic themes with candidates able to sit one or both.

Candidates sat the exams online in their own homes or offices. Security was provided by webcam audio and video, and a second camera such as a mobile phone, while experts invigilated in real time – 40% of cardiac and 26% of thoracic candidates were successful and were awarded membership. Pass marks were decided ahead of the tests by a standardsetting exercise. Following the exam, every question was scrutinised for its performance and each assessment evaluated. Feedback sessions showed that 80% of candidates felt it was the best exam they had taken in their medical careers and 96% would highly recommend it to colleagues; 90% felt it should be compulsory for establishing a standard of competence across Europe and beyond. With the pandemic continuing into June the same challenges faced the Fellowship exam, usually taken at EACTS House in Windsor.

A Zoom-based format allowed candidates to meet examiners in a virtual space, rotating between three stations with short breaks in secure holding rooms for preparation and marking. Exams were held in cardiac, congenital and thoracic surgery, closely following the format of the traditional exam with no compromise in standards – 86% of candidates were awarded the Fellowship in cardiac surgery, with pass rates of 89% in congenital surgery and 75% in thoracic surgery. In the feedback session, candidates felt that the virtual format had worked well.

Thanks go to Amanda Cameron, the Board members and examiners for meeting the challenges. Their commitment and invention delivered exams in new ways to maintain professional standards in cardiothoracic surgery, inspire patient confidence and allow career progression for young surgeons. The new format will continue to develop. It is favoured by candidates and makes exams more accessible, extending the global reach of EBCTS and EACTS, who remain committed to raising standards through education, training and the highest level of professional assessment.

European Board of Cardiothoracic Surgery Board member and examiner opportunities EACTS is currently accepting expressions of interest from qualified applicants for a Board Member position on the European Board of Cardiothoracic Surgery (EBCTS). EBCTS is also seeking applications from EACTS members to join as examiners. Applicants can join as Level 1 or Level 2 examiners in adult cardiac, congenital or thoracic surgery. You can find full details of the responsibilities and qualifications for the Board member and examiners here.

80%

of candidates felt it was the best exam they had taken in their medical careers

96%

would highly recommend it to colleagues