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The important thing about controlled simulation is that it allows us to exercise the reasoning, which will lead us to a diagnosis

DR. LUCIANO ARAMBERRY

Interventional cardiologist at Hospital Italiano de Rosario in Santa Fe (Argentina)

"I was born in 1980, and I have been a physician since 2005, a clinical cardiologist since 2009, and an interventional cardiologist at Hospital Italiano de Rosario (in Argentina) since 2014. I have experience in clinical research since 2006 and in basic research since my time as a student. As highlights, I am a member of the Argentine Federation of Cardiology, Argentine Association of Cardioangiologists, and Rosario’s Cardiology Society." This is an introduction letter from Dr. Luciano Aramberry, a Practicum Script user who sees in the platform a series of common and well-designed clinical scenarios that are beneficial for practice.

Madrid, November 26, 2018. Tell us about your health care practice: What does PS provide in this context?

In my health care practice, I treat patients with various pathologies, and since they belong to an elderly population, heart failure and ischemic cardiac disease are prevalent. PS contributes by offering common concrete and well-designed clinical scenarios, which are helpful in rethinking the pathology and its presentations.
In my tertiary center, most patients are from the Argentine National Institute of Social Services for Retirees and Pensioners (PAMI). My practice is spread across procedures in the hemodynamics unit; I am the coordinator of the Coronary Unit, and I treat outpatients and patients in the general hospital ward.

Could you mention a case that exemplifies what you have learned with PS?

At this moment, I have many in mind. I remember one in particular about the treatment of hypertrophic cardiomyopathy, since this pathology is not very prevalent in my center.

Is this your first course with us? Would you recommend the tool to other specialists?

Yes, I would recommend it as an educational tool without any doubt.

Your indicators are particularly remarkable. How do you deal with each new case?

With each new case, the most important thing is to listen to the patient. They tell us what is happening to them, which in my opinion is the most valuable information that one can use to start thinking about differential diagnoses.

To what extent is it worth to leave behind the formats of mere rote learning to bet on controlled simulation environments?

It's very valuable. In my opinion, rote learning is not useful in the long term. Valuable tools have emerged and are available to any professional to help with the recall of scores or criteria. The important thing of controlled simulation is that it allows us to exercise reasoning, which will help us reach a diagnosis or [recommend] a more appropriate treatment.

Is your reasoning better now?

Without any doubt. A program like PS improves the reasoning ability daily with each new challenge.

Do you think that medical error correlates with gaps in clinical reasoning?

In my opinion, medical error begins with poor questioning and history taking. The absence of these pillars and an overrating of the usefulness of complementary tests often lead to unnecessary expenditure in the health care systems and iatrogenesis, which entails the medical act itself.

How is medical error addressed in the specialty that is recognized as the leading cause of morbidity and mortality?
Medical error is clearly the most feared enemy. All efforts should be aimed at limiting its occurrence. However, it will continue to happen, and in this case, we must try to control its consequences with our dedication. It is a difficult task, and PS is a helpful tool in this regard.

Is it healthy to question? How do you approach situations without categorical evidence?

Questioning is healthy: it helps us rethink and look for certainties and, in this sense, helps us become better doctors. In the absence of categorical evidence, I favor the opinion of experts.

What role does clinical expertise play in patients who fall outside the norm?

It is fundamental. I face this situation very often in my center. [Working with] a population with multiple comorbidities in general, many are not represented in multicenter studies, from which guidelines recommendations emerge. Because many patients are excluded from multicenter studies for different reasons, few are represented, and in these cases, clinical expertise plays an essential role.

Testimonies

For me, the program is very interesting, since it allows me to sharpen my interrogation and direct it more towards a specific pathology and to have more knowledge of laboratory and cabinet exams. I think it is very important that we keep our medical sagacity throughout our practice and that in the few minutes it takes to answer any of the cases that Practicum Script presents, you acquire more knowledge.

Dr. Miguel Olivares Alcocer

Pediatrician in Guanajuato (Mexico)

I would like to express my gratitude to the Practicum Institute of Health Sciences Research for the opportunity given to Latin American physicians  to access and take different courses of our specialty for the benefit of our dear patients, in my case in Mexico. It has encouraged me to improve myself and keep abreast of the advances in Pediatrics and put into practice the knowledge acquired in the hospital where I work. Thanks friends and congratulations to this valuable team of Practicum Script Education.

Dr. Heriberto Fuentes García

Pediatrician in Sonora (Mexico)

I am grateful for this study tool that, through Nestlé and with this method, allows us to review different issues with cases that confront us in decision-making and serve us in the daily consultation.

Dr. Josué Refugio de León Padilla

Pediatrician in Jalisco (Mexico)

It is an excellent educational support platform for the pediatrician, offers very specific clinical challenges with alternatives for diagnosis and differential diagnoses, with the support of experts, a bibliography and a forum to share opinions. It's easy to navigate and it's fun, a tool that's worth using and making the most of it.

Dr. Guillermo Yanowsky-Reyes

Surgery Pediatrician in Guadalajara (Mexico)
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