Virtual education offers unparalleled, and relatively inexpensive opportunities, but the joy of interacting in-person with colleagues and, frankly, appreciating a fine vintage after sessions, are both hard to replicate online, Jens Fiehler, professor and chairman, Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, and vice-president of the ESMINT conference, tells NeuroNews.
What first attracted you to the field of neuroradiology?
I still remember the university lecture as a student when I learnt that specialists can puncture patients in the groin and access a brain aneurysm from there to place small platinum coils “that cost as much as a small Mercedes-Benz”. In that moment, the question of my future specialisation was answered.
How have your mentors in the field influenced you?
The mentor who most profoundly influenced me was certainly Hermann Zeumer, who was the first interventionalist to treat acute stroke by intra-arterial fibrinolysis in the early Eighties. He is a very practical no-nonsense physician, a philosopher and visionary at the same time. His dedication to patients and his thoughts on strategy influenced me a lot. There were also other influential mentors in the neurointerventional space that I had the pleasure of working with, such as James Byrne. My early scientific work on ischaemic stroke imaging and my scientific thinking in general was very much influenced by neurological mentors Joachim Röther and Cornelius Weiller.
How has the pandemic changed ESMINT’s approach to delivering education?
We saw a rapid increase in the number of participants in our webinars. Our beloved annual conference in Nice in early September has gone completely online. We are developing virtual concepts for our training courses ECMINT and EXMINT to be prepared for any situation. Even before the onset of the COVID-19 pandemic, we started exploring livestreaming from angiosuites for teaching and proctoring, to address the need for support during acute procedures. Using a specifically designed remote proctoring technology, we started a training programme for acute stroke cases in Romania (EastMINT) and this month we commenced the e-fellowships in Milan, Basel and Stockholm, connecting these renowned mentor sites with selected trainees across Europe (eFellowship). With COVID-19, the relevance of both projects increased exponentially and we are very excited about the future development of these programmes.
What are the positives and negatives of delivering virtual education in the field of neurointervention?
The positive is the achievable scale. With one webinar, you can reach 500 people easily and inexpensively. People from remote and less-wealthy regions can participate more easily and keep up with new medical developments. And with livestreaming capabilities, we can even provide educational support during acute procedures to anyone, anywhere. The major disadvantage is missing personal discussions and camaraderie between the lectures and – let’s face it – the wine in the evening! Many joint projects and good ideas are developed in unexpected moments.
What has been the most important development in the neurointerventional field during your career?
The most important development was the discovery of effectiveness of stent-retrievers for the treatment of large vessel-occlusion stroke. By some “stroke” of luck, my practical interest in neurointerventions and my favourite scientific subject merged with this breakthrough therapy.
What technological advances do you see shaping stroke treatment over the next 10 years, or beyond?
A key development will be the increasing adoption of electronic communication connecting interventionalists to roll-out new devices in a safer way. Further, I believe robotics will play a serious part one day, but it is going to be a long road. Certainly, we will see many more studies with neuroprotective agents, such as in ESCAPE- NA1. Some of them will hopefully be positive. Perhaps the stenting of symptomatic nonstenotic carotid arteries will be another arena where we can help our patients.
What advice would you give to those beginning their neuro career?
- There are many ways of doing things right. Start with strictly following one beaten path in your practical processes, but question everything, right from the beginning.
- Be aware of your biases and the biases of your teachers. We all have them.
- Use standards and routines to free your mind for creative stuff in research and beyond.
- Be disciplined.
- Synthesise your learnings and find your own way later.
- Try to understand the truth behind the obvious.
- Treasure the scientific method of formulating hypotheses and trying to falsify them. Do it as strictly as you can.
- Try balancing textbook (yes!) learning and digesting neurointerventional tweets the same day. Master this skill.
- Grasp your chances, seize the day, be entrepreneurial.
What are the biggest research questions that you would like to see answered in the neurointerventional field?
It is not so much a specific question that I would like to be answered, but rather a shift in neurointerventional culture that I would like to see completed. I really look forward to moving the needle from anecdotal observations and case series, secondarily rationalised, towards an empirical approach for rigorous testing.
Could you tell us about a particularly memorable case you have had, and what you learned from it?
Unfortunately, there were quite a few real disasters that taught me very specific lesions individually but made me approach my decision making with more humility. I learnt the most from these cases, not from successes. I have shared several of them in neurointerventional morbidity and mortality meetings. This is where science and clinical judgement must come together. It is of course, also important to remember that we neurointerventionalists really positively influence the lives of our patients.
Outside of medicine, what are your hobbies and interests?
I am fascinated by mechanical wristwatches, including their technique and history. With regard to sport, I am a keen runner, and my greater pleasure is lifting heavy weights and stems from, feeling their resistance and the cold metal. Unfortunately, I do not play an instrument, but I am interested in music, especially melodic death metal. I think it is the true continuation from the classic European composers. I like reading management books, but also enjoy re-reading classics, such as the works of Leo Tolstoy and also modern science fiction, for instance the work of Cixin Liu. My interest in cars and motorbikes has been replaced lately by a disturbing interest in do-it-yourself home improvement in our family holiday home.