The story of a fruitful collaboration in Neurosurgery
As the 24th edition of the Romanian-German Course is approaching, the co-president Prof. Ioan-Ștefan Florian, MD. PhD offers an extensive interview addressing such topics as the theme that it is to be discussed at the course, the collaboration between Romanian and German neurosurgeons, and the adaptability as a new lifestyle for the medical world. Also, Prof. Ioan-Ștefan Florian shares the story of this course as an inspirating collaboration between the Romanian and German neurosurgeons that was brought up to light out of the generosity of Prof. Jurgen Piek. The full interview is available below the highlights of this article.
HIGHLIGHTS
- This edition covers a wide array of spine and spinal cord pathologies such as congenital malformations, degenerative conditions, oncological and vascular ailments, traumatic, and infectious injuries.
- Young Neurosurgeon’s Corner is organized for residents and students as a case presentation competition awarded with diplomas, and cash prizes.
- The story of the Romanian-German Course started as a necessity when Romania possibilities were limited and was brought up to light out of the generosity of Prof. Jurgen Piek .
- There are not actually divergent opinions between Romanian and German approaches, but a difference in personal experience.
- As the small number of neurosurgeons from Romania compensates by a large experience, the workload per individual surpasses other countries, including Germany.
- In neurosurgery there are no two completely identical cases.
- The medical world has adapted rapidly to the restrictions and the advent of virtual and simulated interventions partially compensated the actual practice.
- In order to optimize the activity to successfully treat both COVID and non-COVID patients, the elaboration of a Special Precautions guide and coordinated simulation were needed.
MedEvents: This year marks a premiere for the Romanian-German Course in Neurosurgery. It will take place in the virtual environment and will bring in front of the participants, as in the previous editions, specialists from Romania and Germany. You kept the theme of last year’s edition, an edition that did not take place because of the pandemic, namely the pathology of the spine. Please tell me more about the topic chosen for the 24th edition of the Romanian-German Course.
Prof. Ioan-Ștefan Florian: The subjects covered in the Romanian-German course respect a six-year cycle, corresponding the residency curriculum from Germany. This year, we retake the subject reserved for the previous year, since, like you mentioned, we had to cancel due to the start of the pandemic. This year, however, we decided to overcome the lack of another face-to-face meeting by organizing an online course, taking advantage of both our experience from similar events around the world, and the amazing platform and conditions offered by our continuous collaborator, MedEvents. Regarding this year’s subject, similar to each and every other year, we attempt to cover as much as we can from the wide array of spine and spinal cord pathologies, from congenital malformations to degenerative conditions, and from oncological and vascular ailments to traumatic or infectious injuries.
“All topics presented are based on the most current theoretical data, as well as the practical experience of our speakers, speakers who generally present topics from their own professional expertise.
Furthermore, as usual, we also organize a Young Neurosurgeon’s Corner, an initiative that allows residents and students alike to present short talks on clinical or experimental studies, this being an excellent exercise in their training as physicians, professors or speakers at future scientific events. Also, in this regard, we created a competition, the best three presentations from this Corner being awarded with diplomas and cash prizes or other perks.
MedEvents: We can say that Romanian-German Course have a history behind it, a good moment to go back in time and remember the first edition. Who had the initiative to organize it and who were the specialists involved in that first edition?
Prof. Ioan-Ștefan Florian: In the early ‘90’s Romanian neurosurgery suffered from a significant deficit in theory and technology, at least compared Western Europe or the USA. The possibilities for doctors to travel abroad and perfect their technique were low back then, and the cost of biographic materials was high. Even more expensive were the tools needed to diagnose and treat neurosurgical patients. Under these terms, the Romanian-German Course was born out of necessity. The decisive moment was when two great visionaries, whom I’m happy to call my friends, met; they are Prof. Jurgen Piek and Dr. Adrian Cristescu from the Floreasca Emergency Hospital in Bucharest.
“The desire to support the development of Romanian neurosurgery, to teach new generations of neurosurgeons to work according to current principles and techniques, the immense generosity of someone as influential as Prof. Jurgen Piek made the realization of the first courses a possibility, with speakers from Germany invited by Prof. Piek travelling to Bucharest on their own expense to share their neurosurgical knowledge.
While the first editions did not benefit from such a large participation from the residents, it did represent an important first step into developing a long-lasting tradition. After the brutal and unexpected demise of Dr. Adrian Cristescu, and at the invitation of Prof. Piek, we decided to continue the Course in Cluj, where participation was incomparably larger, encompassing residents around the country as well as students. I must also add that from the very start of moving the Course to Cluj, a tightly knit group of dedicated people in teaching neurosurgery was present and participated in every edition since. Aside from Prof. Piek, I must also mention Prof. Uwe Kehler from Hamburg, who took over the Co-Presidency of the Course from Prof. Piek, Prof. Carla Jung from Heidelberg, Dr. Joachim Oertel from Homburg-Saar. Among these, each year according to the subject of the Course, professors from other centers were invited, Prof. Oliver Glandstadt, Prof. Jurgen Meixensberger, Prof. Fridhelm Brassel, to name just a few.
MedEvents: After these years we can say that this course has become more and more interesting both for specialists in neurosurgery field and for medical students. How has the course evolved in terms of the level of scientific papers presented and the specialists involved?
Prof. Ioan-Ștefan Florian: What started initially as a course where our colleagues from Germany lent us their knowledge, in time became an experience exchange, with some of the topics presented as either the „German perspective…” or the „Romanian perspective…”
“Recently, we discovered that there are not actually divergent opinions, but a difference in personal experience, topics being presented by both Romanian and German speakers.
Evidently, both the quality and content of the presentations had known a continuous progress, with the Romanian-German Course not being in any way inferior to other educational events in other parts of the world. I especially want to address the progress in the presentations made by the residents, an aspect which was always mentioned by the German speakers.
MedEvents: What are the goals you set for this year’s edition?
Prof. Ioan-Ștefan Florian: The primary goal was of course to keep this course alive, to sustain this initiative and continuous collaboration that may serve as an example of cooperation even outside medicine. The selected topics are current, the speakers possess a wide experience in spinal pathology, so we expect a participation as numerous as in the previous editions, despite the online format. The fact that the course is certified with 19 EMC credit points offered by the European Forum that governs the continuous medical education in the EU further makes it attractive to physicians and students within and outside of Romania. Last but not least, an online course may be a challenge in of itself, yet we are confident that with MedEvents organizing this Course it will be a resounding success.
MedEvents: How important is the continuation of this exchange of information between Romanian and German specialists?
Prof. Ioan-Ștefan Florian: The course format that we hold is more than a simple lecture, it also mixes in debates regarding scientific data and personal experience. The allotted time for each speaker is enough to allow both theoretical elements and experience in a certain field, whereas the discussions have always brought debates and exchanges in experience, all very useful for the training neurosurgeon. As such, the format and structure of each Course is a great opportunity for each of the participants to enrich their theoretical and practical body of knowledge.
“Additionally, the Course itself embodies a partnership that has become tradition, an example of cooperation in education based on collegiality, respect, and friendship.
Considering all these reasons, as well as the appreciation from the participants, the Romanian-German Course will endure for the foreseeable future.
MedEvents: What are the common elements between Romanian and German medical practices. Can we talk about different approaches?
Prof. Ioan-Ștefan Florian:
“If 30 years ago we could easily talk of differences in approach and concepts, these differences have now been mostly blurred due to globalization and ease of transit.
Globalization also encompasses the wide availability of information, technologies, and surgical techniques and research. Neurosurgery is still an infant specialty, only becoming a distinct specialty at the dawn of the Twentieth Century owing to the vision and efforts of general surgeons possessing both the curiosity and courage to systematically tackle the lesions of the central nervous system. Sir Victor Horsley from the UK, Fedor Krause from Germany, Thiery de Martel from France, and Harvey Cushing from the SUA are the pioneers of global neurosurgery. Germany has always been at the forefront of neurosurgical development, and once technological advancements were made, it was even farther ahead of its peers. Germany practically “set the tone” on a European scale, and the rest of us then strove to learn and to adapt their progresses to our current conditions. It is probably neurosurgery that has known most of its advancements and growth due to technological breakthroughs. The operating microscope is practically the greatest such example, was first introduced in Germany, the first generation being manufactured by Zeiss, and as of today, Germany is still a world leader in the production of surgical equipment and instruments. Companies such as Zeiss, Aesculap, and BrainLab to name a few have continuously developed pioneering technologies in a permanent collaboration with neurosurgical departments, their specialists also being members in neurosurgical teams. While our own department does not have engineers in our operating theatre, we are beneficiaries of recent technological progresses via significant investments. On the other hand, neurosurgery demands practical experience. For now, neurosurgeons cannot be replaced by robots and artificial intelligence. This is where the small number of neurosurgeons in Romania may pose an unexpected advantage: we compensate by a large experience and workload per individual that surpasses other countries, including Germany. As a result, these bilateral discussions constitute a great opportunity to exchange ideas and experiences, beneficial for both sides, and especially neurosurgeons in training.
MedEvents: Can we talk about two „schools” of neurosurgery, techniques practiced in Germany and techniques applied in Romania? We all know that the neurosurgeons also do research.
Prof. Ioan-Ștefan Florian: Clearly, there are neurosurgical schools, and as I already mentioned, the German School of Neurosurgery is among the best in the world. In Romania, the first ever neurosurgical center was in Iași, under the tutelage of Prof. Moruzzi, taught at the French School of Neurosurgery. Later, the center Bucharest was formed, under the leadership of Prof. Bagdasar, who had studied in the USA in the department led by Cushing. The centers from Cluj and Tirgu Mureș were formed afterward, being directly influenced by the German and the English Schools. Each of these Schools, had or has its very own mentor who, by assimilating theoretical knowledge and a variable degree of passion towards learning and teaching, directly affect the growth of a certain School, and the same goes for the rest of the world as well. If evidence-based medicine created therapeutic protocols and guides, today’s focus is personalized medicine.
“In neurosurgery, this translates into the fact that there are no two completely identical cases.
This is where the influence of the School one was formed, and their personal experience comes into play. To give an example, the same cervical spinal fracture may be approached anteriorly by some, posteriorly by others, or combined by a few. The same goes a vertebral tumor, wherein some may sanction vertebroplasty, others a limited decompression followed by radiotherapy, and then a few would recommend complete resection and vertebral body replacement with anterior or posterior fixation. Therefore, debating these cases in a group of specialists is beneficial for both the physicians and especially for the patient.
MedEvents: How did you manage in the restrictive period of the pandemic to transmit such valuable information that makes the neurosurgery field evolve and how did you manage to organize this medical field in these complicated times for the entire medical system?
Prof. Ioan-Ștefan Florian: The medical world has adapted quite rapidly to the restrictions imposed by the pandemic, with the scientific events moving onto the online medium, thus maintaining the circulation of information.
“The greatest loss was represented by practical and hands-on courses. This was compensated by the advent of virtual and simulated interventions, which nevertheless cannot replace the actual practice, and the required technology is not accessible to everyone.
Residents in training endured the brunt of this pandemic, as many of the centers in Europe and the world drastically reducing their activity, and some neurosurgeons even being reallocated to infectionists, or intensivist. Fortunately, this was not the case in our department because of the internal organization, making sure that despite the reduced workload, al residents received the appropriate training. As such, all of them had at least 100 surgical interventions by the end of 2020.
MedEvents: Despite the times we live, neurosurgeons have had to continue their work and patients, even those infected with covid, have needed to be treated. Was it necessary to change medical protocols, to find solutions so that, in the end, both patients and doctors to be safe?
Prof. Ioan-Ștefan Florian: It was very difficult to optimize our activity in order to successfully treat both COVID and non-COVID patients in a building dating from 1903 that does not fully adhere to current neurosurgical standards. We have elaborated a Special Precautions guide that addresses how the work groups should follow into physical and functional circuits, the procedure of gearing up with protective equipment, and even the organization of working hours. We have also coordinated simulations with the entire personnel, so that everything shortly became a routine, and everyone understood and respected these conditions. As such, even though the interventional activity in 2020 was reduced when compared to previous years, we still managed to exceed 2000 neurosurgical procedures, a decrease of nearly 500 surgeries when compared to 2019. This decrease was partly the result of a lower incidence of traffic accidents and traumatic events, possibly the only positive aspect of this pandemic, but also the reduction in surgeries for spinal degenerative pathologies, as these are not life-threatening. The number of vascular and oncological cases did however increase, as the reduction of work in other centers meant that we had to receive neurosurgical cases from all around the country.
“We too had to endure more difficult times, for example in November when we practically had to limit our work to emergencies only for a week, though through supplementary organizational measures we still managed to reach a quota of 150 surgeries per month, possibly the highest in Romania.
MedEvents: As I said at the beginning of this interview, this year the Romanian-German Course will record a premiere, it will be organized exclusively online. What message do you want to send now on the eve of the event both to the Romanian and German colleagues who will give presentations during the course, and to the participants who are waiting for information to help them in their daily work in the medical institutions?
Prof. Ioan-Ștefan Florian: To my colleagues in Germany, I want first and foremost to thank you all for your friendship and your continuous work to educate new generations of neurosurgeons. Even though this year is limited to online meets only, I am nevertheless glad to see you all. As for the participants, I can assure you all that we will continue to make the Romanian-German Course a staple in the training of young neurosurgeons, and of enriching the knowledge and experience of the more experienced neurosurgeons regarding spinal pathologies.
Romanian-German Course: SPINE
April 9-11, 2021
ONLINE EVENT
