The Fogarty Institute for Innovation has launched an Advanced Endovascular Training Fellowship, which is a novel year-long clinical training program for postgraduate physicians beginning July 1, 2012. The program will provide fellows with broad exposure to all aspects of endovascular patient care with an emphasis on interventional training. In the program, fellows will partner with the Fogarty Institute's early-stage medical device start-up companies and will collaborate with them in developing new medical technologies.
To learn more about the program, MD+DI's editor-at-large Brian Buntz spoke with James Joye, DO, an interventional cardiologist who developed cryoplasty and the MDEA-winning MitraClip catheter-based mitral valve repair system. He is the director of the Fellowship Program and chief medical officer of the Fogarty Institute.
Q: What is the vision behind this fellowship? How will it help expose endovascular proceduralists to the wide range of interventional and surgical techniques and new imaging modalities?
A: In the cardiovascular field, for people who work in the interventional side of the business in catheter-based repair for arteries and valves and aneurysms and things of that nature, there are very siloed training programs that produce docs that do that type of work. For instance, you can go through a track where you are trained as a vascular surgeon or an interventional cardiologist or an interventional radiologist to learn those types of procedures. But no one discipline really does justice to it in a complete and collaborative fashion. Take interventional cardiology as an example: it is a three- or four-year program. By the time you start with cardiology, and do those first three years and then do your interventional work on top of it, it is another year or two that are dedicated to it. But cardiologists are so busy learning how to do cardiac work that they don’t really have adequate time or immersion in the endovascular and non-cardiac side of the business during their formal training. Likewise, an interventional radiologist has 1400 different procedures that they might be asked to do. And because of the breadth of those procedures, involvement in the endovascular side is oftentimes marginalized. And certainly for the surgical group, many of the people who are the so-called professors that are teaching these vascular surgical residents are still learning themselves how to do the endovascular procedures. So they are a lot less likely to pass on some of the hands-on opportunities to their trainees. Plus they are still trying to learn how to do more high-risk open surgical procedures themselves.
By the time that most physicians who dedicate themselves to an interventional type of practice, they are done with their formal training. They really haven’t scratched the surface if it is their true intent and desire to be able to manage the entire cardiovascular field—especially in the backdrop of devices coming at a rapid pace and approaches to the disease process is changing on a regular basis.
Q: Could you give me a thumbnail sketch of the history of the fellowship? Where did the inspiration come from?
A: I started to train post-doctoral physicians—those who had already finished their training about 15 years ago now. And that was at a time when the knowledge gap was pretty profound. I was offering courses that were reasonable for physicians to step out of their practice and get a little information and then go back and try to provide for their patients. But these were of a relatively short duration. They would come in for a couple of days, spend a couple of intense days doing a significant procedures side by side, getting a number of didactic lectures and then they would go back. I found over a period of time that there were kind of three camps of doctors that came into these types of programs:
But the group that really looked at this as a complete game-changer in their professional life wanted more and they came back to six or eight courses in a year. They kept getting a little bit, and then going back, getting a little bit more and going back, and continued to up their game. And that worked out well for really motivated individuals but we were typically getting cardiologists that were already well into their careers.
"The intent then became: we are going to make a fellowship that people are going to dedicate a year of their life to and we are going to force the immersion of people who come from different approaches to this."
That kind of evolved into a minifellowship where we took physicians for three months at a time. And what we discovered in that experience was that we could give them a little bit of a more intense approach to this than intermittent shorter-term courses, but three months didn’t really do it justice. So the people that were leaving after three months were left thinking, ‘well, I feel like I really need to come back and do refreshers and get more experience and so on.’
And all of this led to the need to kind of do this as a formal year-long program. It took a while for us to understand that the appetite was out there; that there were physicians who were interested in taking yet another year on top of their many years of training to get this specific type of training. In making that transition and in being involved with Vascular InterVentional Advances (VIVA), which is a national educational course in this field, the opportunity was presented to do this in a truly collaborative, multi-disciplinary fashion.
So the intent then became: we are going to make a fellowship that people are going to dedicate a year of their life to and we are going to force the immersion of people who come from different approaches to this: surgeons are going to work with cardiologists who are going to work with radiologists. And they are going to not only going to learn from people like me who are working on the fellowship, but they are going to cross-pollinate the things that they have already learned for the betterment of the program.
Q: Who is an ideal candidate?
A: We are really looking for progressive open-minded collaborative future leaders of the field. We are trying to identify the next-generation of docs that will take care of cardiovascular patients in a comprehensive fashion. That requires them to live in a combined environment where they are going to work in the surgical OR, they are going to work in the interventional suites, and they are going to learn imaging. They are going to put all of the pieces together that are going to help them to practice the field the way that it really requires.
In other words, we are looking for the cream of the crop.
Q: Because you specialize in treating cardiovascular disease, and have made pioneering contributions to endovascular care, how do you personally relate to the mission of this fellowship? There must be a connection there.
A: Absolutely. The challenges that I have had to live through in my own career was in many ways the impetus for this type of fellowship. The turf wars that exist between the different disciplines in most institutions really prevent people from working together to the full benefit of the patient. And I certainly experienced that in my earlier professional career. I saw that physicians that had an interest in the same area would try to put up barriers to allowing physicians like myself to practice freely and to practice to the best of their abilities and to actually agree to come to the table to work in that kind of a collaborative spirit. And so the fellowship is designed to create a home for that collaborative approach to training. It is an outreach certainly of the collaboration that we are trying to engender through Vascular InterVentional Advances, who brings together equal partners in a national venue.
"The turf wars that exist between the different disciplines in most institutions really prevent people from working together to the full benefit of the patient."
It has certainly been very enjoyable for me being involved in device development for a number of years. When you are involved in that process, you naturally are going to touch each of those disciplines because they are all potentially users—people that are going to want to have their hands on technology and it has just been very educational and gratifying to me to work alongside surgeons and radiologists as well as the cardiologists that I came from and understand how they just have incredible talents. We are really trying to find ways to break those barriers and get people to the table together.
Q: What advice would you have for physicians looking to enter the medical device industry? Is it difficult to juggle clinical practice with device development?
A: It is a challenge, no question about it. The day job is usually a more than a full-time job for what most people recognize. So a lot of this work is being done at the expense of the rest of one’s life. For me, that is typically comes at the expense of sleep. But it also eats into the evenings and weekends and time with the family and all of those kinds of things. If you are going to innovate and go down that path, you have to be very passionate about it and you have to understand the sacrifices that go with it. It is also something that you cannot do alone. And I think that the challenge is that people run into is that they may come up with a good idea and they don’t know where to go from there. They have questions like:
There are a million and one things...
And unless you have either done it or know the right people to get in touch with, that is usually where a lot of these ideas end. I can certainly look back 20 years ago and recognize time I saw that same problem. Two or three ideas came to mind that ended up in a notebook somewhere and didn’t go anywhere because I just didn’t know how to go forward. And thankfully I have had some great partnerships and I have learned from a lot of great people on how to get there. One of the exciting things for me right now in my role with the Fogarty Institute is the ability to participate in that process with young innovators. And Thomas Fogarty has created a safe haven so that people who have those early ideas can get the guidance they need without the risk of having their ideas stolen or having their equity or intellectual property taken by some other entity, in which case it would make the exercise not even worth doing. It is a good way to go now. Entities that are like the Fogarty Institute are few and far between.
Q: Anything else you would like to add?
A: We are openly accepting applications at present. There is an online application process that is on the website. That along with some frequently asked questions and other basic information surrounding the fellowship.
Brian is the editor-at-large at UBM Canon's medical group. Follow him on Twitter at @brian_buntz.