An Unforgettable Learning Experience: Dr. Orvin Katia
1. Please provide an overview of your fellowship at your hospital and the role you played during your stay.
I spent one month (April 2015) at the Columbia University Medical Center – in the Cardiology Critical Care Unit (CCU). I worked under the supervision of Dr. LeRoy Rabbani. I joined the CCU team as an observer, but I participated in all of their activities during the day. Every day I took part in the morning meetings which were better known as Ground Rounds and took place from 07:00 a.m. to 08:00 a.m. Later on in the morning, I participated in rounds in the CCU unit. During lunch time, I joined the daily academic program of the entire cardiology department which included events like the Journal club, update lectures and an ECG course. During the afternoon I joined the routine CCU work such as bed side procedures, new admissions, Cath lab procedures, etc.
2. Describe how your fellowship opportunity has expanded your knowledge in your specific field.
Thanks to this observational visit, I was exposed to various clinical cases and to different management approaches for these cases as well. My visit expanded my knowledge most in the field of supportive treatment to end-stage heart failure patients. Additional I now have a greater acumen for pharmacological treatment and palliative treatment. Moreover, I was introduced with the concept of “nurse practitioners” and “physician assistants”, who occupy the position of interns and fellows in the different hospital wards.
3. What did you enjoy most about your fellowship opportunity?
I mostly enjoyed the morning rounds. I found morning rounds to be very educational and especially on the concept of palliative care, which is less practiced in Israel.
4. Do you feel international medical relationships and fellowship programs are vital to the future of medicine and research?
I do feel very strongly that medical relationships between different departments and different countries is fundamental for research and academic corporations.
5. Explain the major differences between the Israeli health care system and the United States private healthcare systems in terms of your specific field.
There are many major differences between the health care systems concerning the Cardiology department and the CCU in particular:
- The health care in Israel is not driven by private insurance issues. All patients in Israel have a basic health insurance which is provided by the government; therefore when a specific medical treatment is considered, financial costs are not integrated in the decision making process.
- The medical staff in Israel which occupies the CCU is very different than that of the CCU where I completed by fellowship. In the Columbia CCU there was a significant amount of staff. There were general nurses, nurse practitioners, physicians (fellow, attending, medical students), secretaries, and different coordinators/technician who occupy the unit at all time. In Israel the medical staff is much more limited. Practically in Israel, one person performs the same duties that several professionals perform in the United States. This of course stems from major financial health care differences. On the one hand, it may lead to dissatisfaction, a large workload, and stress. However, there is a more personal relationship with the patient since only few people are taking care of him or her.
- The issue of palliative care, end of life treatment, DNR/DNI and active termination of supportive treatment are issues that are much less familiar in the Israeli health care system. This is due religious issues and lack of legislation. The issues of palliative and end-of life care have a significant impact on the health care providers.
6. What do you feel are the key issues and challenges in your field – not only in the Unites States and Israel, but worldwide?
The key issues and challenges in my field are the need for profound research in specific field in one hand. This is extremely difficult due to the flooding of controversial data.
7. What are your future plans at Rabin Medical Center when you return to Israel?
My future plans are to become a CCU attending and to keep on handling pre and post evaluations at the TAVI clinic. Furthermore, I hope to continue my academic work, research and publications.
8. Would you recommend this fellowship to your peers? Why or why not?
I would definitely recommend this observational visit to my peers. I think being exposed to other hospitals and departments, different approaches and medical therapies is very important. Furthermore, I believe that this visit is the best way to form an initial relationship with a potential fellowship location in the future.
This visit exposes us not only to the hospital/department itself, but also to the everyday life in the region of choice.