Nils Witt: International meetings give Sweden a window into other educational systems

Nils Witt (senior consultant, interventional cardiology South Hospital (Söders-jukhuset), Stockholm, Sweden) is the chairman of the Swedish working group on PCI and valve intervention. He reviews the advantages and disadvantages of the medical education system in Sweden and also explores the benefitsof attending medical conferences, such as EuroPCR.

In Sweden, it takes about seven years to become a licensed physician (i.e. able to work independently) – this includes fiveand a half years of medical education and two years of supervised practice. However if you want to be a cardiologist, you need a further fiv to seven years of medical education (a combination of internal medicine and cardiology; double speciality). To become an interventional cardiologist, you typically do your cardi-ology specialty firstand then you do your interventional training. Therefore, most people are already trained cardiologists before they start with interventions.

Medical education is publicly financedand located at seven university centres with a very similar standard of education. In contrast, interventional cardiology training is decentral-ised to 27 centres of different size, which means it can be difficultto track the educational history of  individual interventional fellows. To overcome this issue, we (as the Swedish working group) encourage everyone to follow the curriculum of the EAPCI e-learning platform. Also, we are developing a structure in which we have a national co-ordinator overseeing the e-learning platform issues for Sweden and we are encouraging every-one who initiates interventional training to start with that from day one. Furthermore, a two-day examination procedure has been introduced, followed by certificationfrom the Swedish Society of Cardiology.

A strength of the Swedish medical education system is that clinical skills are developed very early on. Medical students, residents and interns are trained in clinical decision-mak-ing and in performing procedures early in their training. However, we should also start training in scientificskills like research work and writing at an earlier stage. In the future, we are aiming for this to change. Historically, there has been a high concentration of scientificwork at large university-associated institutions and less so at smaller institu-tions. But, greater collaboration between smaller centres and larger university centres will mean that fellows at smaller centres (through fellowships and time-limited training periods) will become familiar with the scientificculture of conducting research. Addition-ally, more students are going abroad for exchange programmes and fellowships and I think that will stimulate more scientific work.

In terms of medical education outside of the Swedish medical education system, I know that many of the trainee cardiologists use online resources substantially more often than when I was doing my training 15 years ago. Also, we encourage all trainee interven-tional cardiologists to attend international meetings such as EuroPCR at least once a year. We believe international meetings provide a window into the education systems of other countries and therefore, by attending meetings, we can see good examples of how education is conducted in different countries.