Live Reformation: How Live Courses Can Survive in the 4.0 Era, Vol. 1

While the epidemic has led to the postponement or cancelation of several live courses, the Japanese Bifurcation Club 2020 (JBC 2020) was held online in October, and for the first time in six months, was accredited by the Japanese Society of Cardiovascular Interventional Therapy (CVIT). JBC 2020 was attended by a large number of cardiovascular healthcare workers and industry people. However, this live course was not the place for like-minded medical professionals to gather as it had been in the past. Instead of the usual mingling that accompanies a crowded room, the peoples' only option was to stare at the event through the computer monitor on their desks.

The coronavirus disaster marks a major turning point in the form of live courses, which were first held in 1978 by Andreas Gruentzig. Now that live courses can be viewed anywhere and at any time without the need for travel, will we return to holding them on-site in a single location as in the past?

In this article, we will look back at the history of live courses in catheter intervention, and consider their future as the external environment continues to change.

Birth of the Live Course (Pre-Live 1.0 Era, 1983)

The world's first percutaneous coronary angioplasty (PTCA, later renamed to percutaneous coronary intervention [PCI]) was performed by Andreas Gruentzig in Zurich, Switzerland, more than 40 years ago (September 14, 1977).¹ The Medical Polyclinic of the University of Zurich, where he was working at the time, welcomed visitors from all over the world in order for them to display their innovative treatments. At the time, however, Gruentzig was in his late thirties and in a mid-career position within the hospital, which caused a backlash against his work style and a constant turnover of visitors who wished to observe his procedures. Frustrated by this, Gruentzig thought that if the problem was for him having too many visitors in his cath lab, he should instead gather all the people interested together and broadcast it directly to them.² In 1978, one year after the first case, he conducted the world's first PTCA live course.³

Courtesy of Angioplasty.Org

The number of participants in this first live course recorded was 28. Gruentzig, who had treated 25 patients since performing his first PTCA, treated seven patients in his first live course. Two years later, in 1980, the live course included masters in the field such as Melvin Judkins, who performed the first femoral artery catheterization, Charles Dotter, who invented the concept of "-plasty," and Mason Sones, who developed the selective coronary angiography.⁴

The first live course on coronary angioplasty in Japan was held in 1984 by Dr. Masakiyo Nobuyoshi, former Director of Kokura Memorial Hospital and a pioneer of PCI throughout the country. Prior to that in October 1981, Dr. Nobuyoshi had performed the first PTCA in Japan, and after accumulating experience for several years, he disseminated the techniques he had established throughout the country. He also introduced the live course, which was then becoming popular in the United States, to Japan.⁵

The live course greatly changed the method of education in the catheter room, where previously only a limited number of people could observe. At that time, the expert interventional cardiologist would organize the live course and relay the procedure from the catheterization room to the medical office or conference room, where the participants gathered, and he would carefully instruct them on everything from the puncture of the femoral artery to compression hemostasis. The birth of the live course also changed medical education, which had been traditionally concentrated in universities. In more conservative university hospitals, it was unthinkable to open the cath labs and operating rooms to the public, and there was no environment in which the techniques and treatment methods developed in university hospitals could be easily communicated to people other than their own colleagues, or in which they could accept the techniques and treatment methods developed from other schools of thought. As a result, the role of promoting PTCA was taken up by Nobuyoshi and his disciples who worked in private hospitals.

1. Meier B. N Engl J Med. 2001; 344: 144-145
2. Gaspard P. 2017 The History of Coronary Angioplasty. Europa Digital and Publishing/Europa Group
3. PTCA: A HISTORY. 2017; Venture Digital
4. Andreas Gruentzig's Second Teaching Course https://www.pcronline.com/About-PCR/40-years-angioplasty/Education/First-courses (viewed August 2021)
5. Profile: Dr. Masakiyo Nobuyoshi (Part 1) https://www.tcross.co.jp/node/1379 (viewed August 2021)

About the Author: Satoru Hashimoto
After graduating from Bellevue University in Nebraska, USA, in 1994, Mr. Hashimoto returned to Japan to work for a foreign healthcare consulting company before joining Johnson & Johnson. After a career in sales and marketing in the field of catheter intervention, he established TCROSS Co., Ltd. In 2005. He enrolled in the Graduate School of Management, GLOBIS University in 2019 and graduated in 2021 with an MBA (Master of Business Administration). He is a full member of the Japan Science and Technology (JST) Journalists Conference and the International Science Writers Association (ISWA).