Nicolás Chichizola is a young Argentine cardiologist. He is 37 years old, practices medicine in Rosario, province of Santa Fé, and combines his activity in public and private practice. He had experience as a resident instructor and earned his medical degree with honors. In addition, he trained at the Vall d'Hebron hospital in Barcelona (Spain) and Loma Linda in California (USA). In his opinion, “we must keep ourselves constantly update, but it is convenient to be selective.” Practicum Script covers this need.
Madrid, June 27, 2018. Asked about the percentage of adverse events in hospital admissions published by the newspaper La Nación one year ago (12.1%), the Argentine cardiologist Nicolás Chichizola is convinced that “the reality is that in South America the percentage of medical error is probably higher because there is no accurate record.” The need to learn from error is the first lesson he points out: “Personally, last year I attended a course in medical error through the private institution where I work, and the percentage of errors and their consequences turned out to be pronounced.” In his view, it would be advisable to create safety committees, and later, quality committees, and begin to consider the error from a non-punitive perspective.
According to Dr. Chichizola, qualified by the National University of Rosario and specialist at the Cardiovascular Recovery Room of the Hospital Provincial del Centenario, there must first be a change of systems, which are complex in the health care area, and this must be accompanied by the implementation of clinical reasoning. “In my country, the long working hours, the lack of retribution, and the demands of the institutions and patients lead the professional to exhaustion.” That is why “I believe that certain changes should be combined; especially those of systems and institutions, and probably after these obstacles are overcome, tools like Practicum Script would have the weight to reduce occupational stress and, in the process, implement clinical reasoning and correct the medical error rate.” What differentiates this simulator is that it breaks with directed thinking. “The greatest learning is related to different hypotheses and clinical scenarios.”
From his point of view, mere learning from memorization is of little use: “One of the major problems as a residents’ instructor is to make them think and move away from traditional and simplistic approaches.” Following the exposure of facts, clinical reasoning training improves patient care as it reverts to a constant update of knowledge and thinking skills. He states: “It has been useful during visits to the wards with residents to broaden the rationale in different diagnoses and treatments.” However, “I think we should not have time at the expense of care since a good part of the answers to our diagnoses lies in our contact with the patient.” That is, the evaluation of competences is important and “we must keep ourselves constantly update, but it is convenient to be selective.”
Attentive to the healthcare practice
What happens is that “cardiologists, by having so many clinical practice guidelines and algorithms, sometimes neglect the capacity of association and deduction. I consider it to be fundamental to simulate several clinical situations in the post-graduation course.” Since he works in several areas (he is also the head of the Cardiovascular and Pulmonary Rehabilitation Program at the Rosario Institute and Chief Resident at the same center), he meets daily with patients who show similarities with the cases from the Practicum Script portfolio. “When it comes to real cases, they represent what we see in everyday life and help us make decisions.” He recalls with special interest a case of ventricular arrhythmia in a young athlete patient. In particular, the resolution of each case takes about 20 or 30 minutes. “It could be less time, but I like to read the contributions of others and the bibliography; I think this adds up because we see other ways of reasoning, thinking, and analyzing.”
Between public health and private practice, in the former, he performs postoperative cardiovascular recovery. “These are low-income patients with a lot more comorbidities, addictions, and propensity to become sick at a younger age. Their adherence to treatment is lower, and access to different drugs is more difficult.” In the private setting, he admits patients and performs secondary prevention, and “the patients are middle-class individuals, with higher educational level, more adherence to treatment, and with better access to medications and treatments.” In dealing with different social classes and multiple conditions, “I believe that, in my particular case, I already have the Practicum Script method assimilated to my reasoning and usual procedures, and I consider it daily.”
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