Panel

Eric Verhoeven, MD, PhD, is with the Department of Vascular and Endovascular Surgery, Klinikum Nürnberg Süd in Nürnberg, Germany. He has disclosed that he is a paid consultant to Cook Medical, Gore & Associates, Atrium Medical, and Siemens Healthcare. He also receives grant/ research funding from Cook Medical and Gore & Associates, and has a royalty agreement with Cook Medical. Dr. Verhoeven may be reached at +499113982651; eric.verhoeven@ klinikum-nuernberg.de.

Jason T. Lee, MD, is Assistant Professor of Surgery, Program Director, Vascular Residency/Fellowship, Stanford University Medical Center in Stanford, California. He has disclosed that he has no financial interests related to this article. Dr. Lee may be reached at jtlee@stanford.edu.

James F. Benenati, MD, is Medical Director, Peripheral Vascular Laboratory and Fellowship Program Director at Baptist Cardiac and Vascular Institute in Miami, Florida. He has disclosed that he is a paid consultant to Gore & Associates, Abbott Vascular, and Cordis Corporation. Dr. Benenati may be reached at jamesb@ baptisthealth.net.

Steven Dubenec, MBBS, BSc(Med), FRACS, is Head of the Department of Vascular Surgery, Royal Prince Alfred Hospital in Sydney, Australia. He has disclosed that he is a paid consultant to Gore & Associates and Cook Medical. Dr. Dubenec may be reached at sdubenec@vascularsurgeon.com.au.

Although some industry-supported activities have recently come under increased scrutiny, it still seems to be an area that is widely perceived as providing value to physicians and their patients. What are your thoughts on the value of industry participation and financial support of physician education activities, and what do you think the future holds?

Dr. Verhoeven: This is not a black and white issue—this is a gray area. You know the argument: without industry cooperation, we wouldn't be where we are, but obviously, there are inherent risks of cooperation with industry that are mostly financially inflicted. It's clear that increased scrutiny is required, but there must be some latitude to do things. It is most important that we are open about industry participation, that we declare what we do, and that financial advantages are clearly stated and probably should not go to physicians directly.

Dr. Benenati: I think that regulatory policies will continue to require more stringent rules on what industry and physicians can do regarding educational activities. I agree that it is very important that physicians openly disclose all of their relationships. One of the problems in the past was that there were conflicts of interest that were not disclosed. This lack of disclosure leads to biased presentations and, ultimately, can result in physicians performing procedures to receive incentives that may benefit a company at the expense of a patient.

I believe industry can continue to support education with full disclosure and with minimal bias. The use of unrestricted grants is a valuable way to be sure that there is support from industry without influence on speakers or CME content. There are many educational opportunities that are procedure-specific or device-specific, and industry support is critical to the necessary training and dissemination of information.

Dr. Lee: These activities allow the rollout of new knowledge and new technology. Although many people have become very experienced with endovascular techniques, there is always room for improvement. As clinicians, we're pleased that everyone has partnered together to come up with better and safer devices and techniques. To introduce new technologies to the experienced users, however, emphasis should be put on educational events. It is often more convenient when these educational events are tied into meetings that we're already attending. Partnering with national or regional societies is an appropriate way to present new technology and education given the current climate of conflict of interest for many academic faculty. Many device companies have supported the Society for Clinical Vascular Surgery and the Society for Vascular Surgery meetings, as well as the regional societies to inform physicians of new products, have tabletop demos, and introduce simulation.

I also think that by industry partnering and supporting a meeting, it often improves the attendance and viability of the smaller societies. It is clear in 2012 that there are a lot of meetings for vascular specialists to attend, and time spent away often means revenue loss from a clinical standpoint. The more we're able to augment meetings with alternate forms of education, the better. I know that industry partners have been very thoughtful, proactive, and supportive of those types of venues.

These educational activities are also good for the fellows and residents. With the introduction of vascular residencies now (the 5-year programs in addition to the 2-year fellowships), we will see a doubling or tripling of the number of vascular trainees that are attending meetings in the next several years. A great way for industry to interact is to help introduce some of the new technology and utilize simulation to help teach the more novice users rather than just the seasoned clinicians.

Dr. Dubenec: The value of industry-supported activities is important. In the right setting, they can provide physicians with an opportunity to update their knowledge to improve their skills and to discuss ideas in an open forum. Without the help of industry-supported education, we may miss an enormous tool that helps to facilitate communication among physicians all over the world.

What we need to consider is that the physician's relationship with industry remains professional and ethical. Open disclosure is important to identify our relationships with industry to our colleagues so as to minimize bias and maintain our clinical independence.

Industry-sponsored education should be used as a tool to provide education updates and opportunity for discussion to further advance our clinical practice that, in the end, will benefit our patients.

What types of industry-supported educational events have the most impact on advancing endovascular medicine? Why?

Dr. Dubenec: There are different kinds of educational events, and they are all important in their own ways. There are the local forums where surgeons meet to discuss a certain topic, such as journal clubs, site visits to other centers of excellence where you see how different groups are employing new techniques and tools, and major scientific meetings. Each type of event can have something special to offer. What is important is that when we attend, we learn something new.

Dr. Lee: Sessions with thought leaders discussing the pros and cons of different approaches are very educational. I think attendees, particularly trainees and community physicians, need to hear different opinions and approaches. When a company brings out lecturers who debate the utility of a device or technique in an honest and open way, it highlights the merits of a particular technology. Although many are focused on endovascular procedures, and patients are clamoring for them, I think that we cannot forget or ignore the fact that we must set up the appropriate clinical studies to prove that the endovascular approaches can be and are as safe as the traditional approaches.

Dr. Verhoeven: Well, we cooperate with companies that give or sell us stent grafts, and sometimes they come here to do demos. This is clearly a very appreciated educational event for the younger doctors. I think the same goes for support to go to conferences, but they must be appropriate. The support must be to go to a conference and to learn something. For example, in Bavaria, Germany, every 3 months we have a Gore evening where there is one speaker on a legitimate educational topic and then a dinner where the clinical discussion is continued. I think that is fairly acceptable. We all like to be in a nice room, we all like to have a good dinner, but it should be balanced with educational value.

Dr. Benenati: It's important to remember that support for specialty society meetings is necessary for them to exist. These meetings have strong scientific content and are the primary way that many physicians receive their CME.

In what ways can industry support fellows' education that differ from how it supports other physicians' ongoing education?

Dr. Lee: Having been involved in a lot of educational sessions and meetings over the years as a participant and faculty member, I believe it is good to spark some sort of competitiveness among the trainees. Surgeons by their nature are competitive, and so trainees may respond favorably in an educational forum if you make the experience some sort of a competition, perhaps prizes for the best research project, the best anastomosis, the best deployment of a device. I think those are all ways to get young people excited about education. In the most idealistic world, we would all want to learn because it's important for our patients, but sometimes, adding a little bit of fun to education can make for a more enjoyable experience for the trainee.

Dr. Verhoeven: To me, the more an event is about supporting younger people, fellows, and new physicians, and the less it is about helping the big guys to go somewhere, the better it is. I think bringing young physicians to congresses is even more important compared to opportunities for the experienced physicians. With Gore or with Cook, we had a fellows' meeting every year where it was really an invitation for fellows only to spend a day or two with a few experienced leaders in the field.

As another example, in Canada, I attended a fellows' dinner during an official board meeting. I had a very interesting two hours there with six fellows who were able to ask questions, and a company supported that event. I think that went very well, and the fellows were happy to have a more private opportunity to talk.

Dr. Benenati: Fellows and trainees also seem to value the ability to have hands-on opportunities. Many times, when a new technology is introduced into a program or laboratory, the attending physicians need to gain experience, and so the fellows are not able to work with the devices. It may be intimidating sometimes for fellows to ask questions with attending physicians and more experienced staff present. Focused time for fellows allows them to learn about new devices and get their hands on the devices, and it gives them the opportunity to ask questions that they may not have been comfortable asking in a larger setting.

Dr. Dubenec: The support that industry provides to fellows can be very beneficial. Fellows really need as much exposure to as many surgical techniques during their training as possible. Industry can support younger fellows with first-hand exposure to products. It's only when you understand the product and its areas of application that you can use and hopefully gain some mastery with it. Workshops, overseas fellowships, and local meetings are all important educational tools that provide in-depth knowledge in a short period of time. I remember gaining experience and confidence through such workshops and know it only improved my endovascular skills.

Are there any specific educational tools that industry can help to provide that bring value to clinicians?

Dr. Dubenec: I really enjoy those area-wide forums for the more advanced clinicians where there is a lot of open discussion. They're the ones that I like the most because you can hear about interesting cases that are difficult and may be pushing technological boundaries and challenging the skill level and skill sets of a lot of people. Once you get a different perspective on those sorts of cases and you see a whole variety of them, you take back a huge amount of knowledge that you might not see, even over a 12-month period.

Dr. Benenati: To me, small-group training sessions on specific topics are extremely valuable. The use of models as tools is helpful. I agree with Dr. Dubenec that using previously performed cases is an outstanding way to demonstrate points relating to technique.

Dr. Lee: I think tabletop demos are very good for fellows, residents, and even junior attendings. These days, as the trainees are learning, we don't often have an opportunity for them to deploy and practice with devices. At a meeting, a demo is a nice way to break the ice with the trainees. Industry has the resources to be able to provide basic education and introduction to the different devices.

I would caution against the typical didactic lectures that simply describe how great a certain device is. Rather than a commercial of the wonderful devices coming down the pipeline, I think lectures should be more about the disease process and how the technology may potentially be applied to help your patients with those diseases.

What has been your most enjoyable/rewarding experience as an instructor for an industry-sponsored educational event? Why?

Dr. Dubenec: The most rewarding experience for me has been to act as a guide for some of the fellows coming through. It is sometimes difficult to discuss questions in certain settings, even if it is with a mentor. These forums are very different from learning at work. They allow you to have an opportunity to sit down with trainees in a comfortable environment away from other commitments and support them. It's nice knowing that when they leave, they have a better understanding of the topic and that they have had a chance to ask other questions that may have interested them.

Dr. Lee: I enjoy meeting the trainees coming up through the ranks. I believe educational events at meetings can be an opportunity for faculty and trainees to have one-on-one time with mentors who aren't their immediate attendings. It definitely makes a difference in the future when looking for a job, getting a recommendation, or trying to sit on a committee for a society.

I've personally become pretty well acquainted with many trainees across the country through such educational events. The vascular community, as we all know, is a very small group of physicians, so networking and making those connections with people not only at my own institution has been professionally and socially satisfying for me.

Dr. Benenati: I personally learn each time I teach, so the most rewarding experiences for me are getting to know attendees at courses and sharing experiences. A wealth of information and insight can be gained from listening to the experience of others. Trying to help solve problems or learning creative ways to solve problems is a common occurrence during these kinds of discussions. Making friends and developing relationships is also a very rewarding consequence of participating in these events.

As a clinician and an educator, how would you describe Gore and its Medical Mastery Series of programs?

Dr. Lee: In the 15 years that I've been both a surgical trainee and a faculty member and have been interested in surgical education, Gore has gone above and beyond their desire to partner with educators to provide training. I think education is one of the company's core missions, and I respect them for that.

Over the past 5 years, having been involved with educational events at many meetings, I think one can get a pretty well-rounded technical introduction/education in vascular prostheses, suturing, endografts, imaging, and clinical trials. These programs often provide education without making it seem like a marketing ploy. The Medical Mastery Series highlights talks that are more about diseases and better ways to treat them, rather than actually selling the device.

Dr. Benenati: The Gore Medical Mastery Series is actually a fantastic opportunity to learn about more advanced techniques for treating AAAs. The small size of the course allows for discussion and interaction that cannot occur in larger meetings. The ability for registrants to bring their own cases ensures that specific issues and concerns that endovascular physicians have can be fully addressed. The multispecialty makeup of the courses allows for cross-pollination of ideas and techniques. Having the programs in different cities around the United States makes it easy for physicians to attend, and the compact program maximizes the efficiency of the meeting so that time away is kept to a minimum.

Dr. Dubenec: Gore's focus on ongoing education and clinical support is, in my mind, one of their best qualities. To provide support and education to clinicians helps one to get the most out of that product and learn how it can be used to its maximal benefit. The Medical Mastery Series is an excellent tool that allows this. These forums are extremely open in terms of Gore not only discussing their own products, but they also discuss other products and how they may be used in different situations. Gore is focused on clinical outcomes, which should be our first priority.

Dr. Verhoeven: This is interesting because I've talked to a few people about this only 2 days ago. I think Gore is a special company because they have a very positive attitude. They are not afraid of being supportive, and they are playing by the rules, which is very important. It's very balanced, it's very open, and it's a very good group.