LACES Experts´insights:
Why be an academic surgeon? – The importance of building a career hand in hand with research
Prof. Torsten Doenst (Jena University Hospital, Jena, Germany)
Hello everyone I’m really gladed to be here again we will provide another interview for our new video section from laces and our guest from today is Professor Dunes he’s the current chairman and director for the cardic Department in Yen University hospital and I also would like to introduce my
Friend Mato who who works in liy Heart Center first of all Professor Dunes thank you very much for your presence and I would like to start asking you if you can give a brief introduction about how was your career who were the main mentors during your pathway yeah too thank you and hello
Everyone and hello Mato um yeah well my career it’s um I started medical school in in gingan it’s uh in Germany in the former East I was actually very close to the former German border where I went to school uh but anyway medical school was in gutting in then and um I uh
Already participated in an exchange program when I was a medical student uh going to Houston for a year of research that was already in the early 90s and I went to Houston to work with the cardiologist the Bas a conservative cardiologist with the basic science interest Hinrich Ted Meer and um so that
Started my research interest I was curious at the time I was motivated I wanted to learn something and um then I came back finished medical school um and um since I could not go to the us directly because I wanted to immigrate actually um I had to do my um well
Internship in Germany before I got my full license in Germany so um I uh went to do one year of U or half a year of cardiac surgery in fryborg because I thought you know going to the us becoming a cardiologist um and I would have to spend another year i’ I’d better
You know look at the surgical side of things and um started in Friberg for a half a year with Fred basor at the time he was a young Chief and um then um after half a year I went back to Houston for two years of more research and and
Had a job lined up in the US and eventually I decided no it’s cardiac surgery because that those six months had ignited my interest and enthusiasm and then I went back to fryberg I did my uh board certification there my training in cardiac surgery um at the end of it I
Added another year of fellowship with Tyrone David in Toronto came back to fryberg became staff there uarts as we say in Germany and then um and then basically the contact to Fred Moore in liik was made and he recruited me to leig where I spent four years before I
Took the chair here in in y interesting interesting there were a lot of details I didn’t know about your career that’s very cool so and now the second question is um I mean most of us as academic surgeons are convinced about the importance of clinical research rcts and retrospective studies observational
Studies but what about basic basic science do you think we should be involved in basic science as surgents what’s your opinion about this yeah that’s a that’s a big Point I’ve always been considered uh a bit of the the the researcher the stranger you know so because it’s not the typical career that
I took you know and uh uh a lot of my students that did doal thesis with me obviously also ended up in cardiology and not so much in surgery uh the number of students that ended up in cardiology was much larger than those in surgery
But any anyway I think um you know over the time uh a lot of things have changed because when I started cardiac surgery um the field was um in many areas free of Alternatives there was it was the only way toh help patients at one a
Certain point in time um there was a lot of activity that had to be developed sort of on the engineering type approach you know things have to be developed operations have to be invented um there was no real need because there was no competition on the one hand and there
Was a lot of engineering type work that needed to be done on the other hand and so I think that’s the way cardiac surgery developed to what it is today um and then things changed because all of a sudden we’ve got all these Interventional Alternatives we’ve got medical Alternatives sometimes and all
Of a sudden we see ourselves as surgeons that’s my perspective in a position where we need to sort of defend our position and our things that we do I mean consider we we are very invasive we are harming people we have the poent potential to make a mistake and a
Patient is dead so you need to have a good justification for what you do and I think this is the time that we live in right now we live in the time where we need to demonstrate what our surgery what our um uh skill our craft can do
And actually is able to achieve and um from that perspective of course clinical research demonstrating the effectiveness the efficacy of treatments is very important so but where where does that leave clinical or basic science okay and um uh I’ve actually this topic has already been part of my um uh uh
Presentation where I presented my not my thesis but my hubon so the highest German degree you give a lecture there and um we had the um the topic at the time was whether basic science was really needed in cardiac surgery we even wrote a manuscript later on uh that we
Publish and the me the main message of that was that if a if a person gets active in research and that is irrelevant whether it’s basic or clinical science if somebody gets really involved and does it at the professional level um this person uh becomes the better surgeon I mean not you better
Than me or or Tulio but um Tulio with training better than tulo without training and we can see this um we can see that I can tell you many examples that whenever a person actually got involved in an academic type of um interaction all of a sudden the clinical
Performance went up and goes up and that’s that’s in my world a very strong uh argument for being involved in research in general and whether it needs to be basic science some have interest in it and some actually even combine it and from my perspective I’ve been involved in mitochondrial work and I
Enjoy it so much that I still have a basic science grant right now where we are involving where we are investigating the role of alternative oxidases in the mitochondrial chain um in in the context of heart failure and contractile dysfunction so you know it not everybody
Has to do it but it doesn’t hurt and if you started early it’s probably obviously best because you uh being involved in basic science also allows you at least in my world I ex learned how to write a review how to write a response to reviewers how to review a
Manuscript those are things those are tools that you need to learn in research um that are similar to opening a chest going on pump coming off pump those are things that you know you you start in the beginning and the better you are at it the faster you are and the better you
Are later able to combine both worlds because um in in I think in today’s world as I’ve addressed earlier it is important for surgeons to combine both you have to be knowledgeable you have to know more about not only about the surgery itself and how to do it but you
Need to know about the Alternatives the impact the effect of the Alternatives um and that’s so you need to have there’s much more academic requirements to the current today’s cardiac surgeon than it is 20 years ago okay that sounds really good it’s a really strong opinion and I have another
Question that goes also in this thematic in your opinion there’s a specific road map for residents when they should start to get involved involved with research and do they need they really need to dedicate exclusively ears just for research what do you think well I I I’ve had many students
And many students asked me whether they have to take a day a year off or so for completing their thesis and my answer has always been it’s not up to me it’s up to you because it’s the person who actually uh wants to learn a lot quickly
Who needs a little bit longer U who is able to juggle two jobs at the same time you know those are things that are individually different and um it is my personal uh conviction that if you do something you have to do it right so if
It takes you four four years to know how to open a chest and close it um then it is four years if you can do it in one year because um you have the chance to be exposed more often you have uh more time you able to invest it you know
Often times I I even think today that people are uh slowed down by the system because of all the regulations that we have you know the Liberty that I have when I was younger I I I could just be there and with the labor laws that we
Have you cannot just be there but you can combine things because you have the same time available to you everybody has 24 hours a day you need to sleep some but then you have to work and you have to balance it with your other priorities and it’s not the system that sets the
Priority it’s not um the employer that sets the priority it’s you the trainee that sets the priority for your success and if that if that’s sort of a philosophy that you know I’m very liberal in that part and so you know I see my role as a mentor now more uh like
Somebody who is sort of the Catalyst for that type of development and so uh if you want to run fast I’ll help you to run fast if you run slow well you run a little slower you may also experience less support then because you know faster people need maybe more I it’s
Very difficult but it is um in the end it comes back to the person who wants to do it and in terms of managing two things at the same time the earlier you learn something right the better if you learn two languages for instance if you grow up with two languages you’re accent
Free you know I’m not accent free um you are not accent free in your second languages but if you were grown if you had grown up with um that language there’s one less thing to take care of at the time so I always thought I started very early in research because I
Was curious and wanted to get my thesis done um and the Curiosity and the uh sort of uh enthusiasm for basic research actually only came then I didn’t have enthusiasm for basic science in the beginning I wanted to get my thesis out of the way and all of a sudden I was
Stuck and it took forever and I’m still involved so that’s the way it goes okay so our final question is can you provide us Insight how has research changed and influenced your life do you can can you really provide to us like this statement how important is to build care here hand
Inand with research well I think um for me I’ve had two people who have been very influential in my um research career and who have basically shaped my way of thinking and acting and the one was a biochemist in in gutan where I went uh
To med school and where I did my thesis and that was professor and he was a biochemist and he taught me how to think analytically and how to think critically and that allowed me to go ahead and that allows me still today to challenge dogmas and then the other thing is the
Other person that influenced me with Hinrich TM in in uh in Houston he’s a basic scientist cardiologist he trained with hun crebs you know the crep cycle guy and he taught me to think mechanistically so he said you need to know why things are happening and I think there’s no other field than
Cardiac surgery that that better needs those questions you need to know why you do things in order to do a procedure safely and correctly if you know how to do if you know why you do the surgery if you know why you do your movement in the
Surgery I mean all these things are very important and they come in my personal career in my personal life from my research exposure and it’s not alone thatan it’s not for nothing that we have the modotto and you know this doio we say cardiac surgery is thinking with
Your hands and that is the philosophy of that and I think that a lot of people know what to do and how to do it but they don’t necessarily know why to do it and if that last step comes in you reach a different level your quality goes up
And that is not sort of a promise or so that’s just sort of for my in my personal experience what exactly happened to me and that’s why I think research and getting involved in research is is very important and the earlier the better great I I I feel very identified
With many of your answers and your points of view but I do have one last question I know we are over the time but um we are two different Generations H and we were not lucky enough to be born maybe 20 years ago well I mean 20 years
Earlier H because you just mentioned it ER the at administrative and maybe even ethical hles were a little bit let’s say lower or easier ER some time ago and nowadays to perform Innovative research and like uh a groundbreaking research is not that easy and maybe not because you
Don’t want to do it but because there are so many different very difficult steps that H don’t allow to do it as easy at it as it was 20 years ago H so my question is what what would be your recommendation to be a little bit Innovative and to uh still improve
Research and improve um maybe even basic science um in in the nowadays regulations well the Americans have a very nice saying that goes hindsight is always 2020 you know that means that now where if we look back everything was so easy then it wasn’t easy then
It was difficult and it was difficult to have a good idea and if you now look back into the New England Journal papers or to the lanet papers from 20 years ago you say ah this was an easy idea you know that it was just as difficult then
That it is now and I also I think that you’d have to just work hard think hard and the more you get involved with the topic the more you get competent in that topic the more ideas you will develop and the the things that may turn out not
Everybody not everybody wins the Nobel Prize but you know the more you you get involved in things the more the greater the chance that something reasonable and decent comes out and so from that perspective I would just uh say you know work hard do what you can and um I also
Don’t believe u in the idea that the new generation you belong to it you know that you are not good enough or whatever every older generation always thought that the Young Generation was not up to it you know that you can go many many generations back I have no problems and
I see so many young driven I have two right here two you know representatives of that young generation who are very driven and motivated I have I have no uh no worries that um we will face a great future and you will uh come up with great Innovations and I think the
Innovation will sort of which has been shift to uh Interventional uh Interventional Cardiology more in the past decade maybe or two um I think that Innovation may just as well swing back you never know because long-term outcomes will F and we need to just qualify ourselves academically scientifically to sort of
Live that life we the TW the past 20 year or the the 20 years even before me before my career started they were uh not they had no Alternatives that was cardiac surgery was the only thing there and when I was your age I was the fellow
In uh in in Toronto and Tyrone David told me this is it you know cardiac surgery um the good times are over this is it and uh so he promised that there there is no more development and I personally feel that I’m doing I’m in a
Fantastic field and I very much enjoy it and I see a lot of potential in our field which has not been um sort of generated and developed yet and um it’s up to us and up to you to actually develop it so I’m looking very positively into our
Future okay that’s really amazing we end up our interview with this incredible answer and we thank you again Professor D thank you very much for your presence here pleasure thank you