Of Medical Conferences and their Continuing Relevance... by Dr David KL Quek

Of Medical Conferences and their Continuing Relevance


by Dr David KL Quek

I thank Dr Patrick Cheah (of Caduceus, a Facebook discussion group) for raising the topic about the utility or futility of huge medical conferences, which set me thinking... In fact lately, several journals have touched on this and debated even predicted the demise of these conferences, which some feel strongly is passe in this era of internet connectivity and open access information availability.

As someone who regularly attends these types of conferences, I have to partially agree with him, but not entirely. For the uninitiated and the novice, attending huge medical conferences could be an intimidating and perhaps time-wasted event... 

Of course, some people do come just for the 'vacation break' or the junket of trade sponsorship! But for many others particularly young research clinicians presenting the papers for the first few times, these are experiences which enrich and are awe-inspiring, challenging and reinforcing the scientific method of inquiry, learning and sharing!

I have just returned from the recent ESC 2012 in Munich, which was a costly affair (895 euros, excluding airfare and lodging and food), and some might argue that this was simply not worth it... but I beg to differ. Yes, the conference site was humongous and the daily counted attendees ranged above 27,000 per day for at least 3 intense days. 

The biggest hall Munich Room accommodated around 8,000 participants and then they were closed for late comers queuing to get in and had to be ushered into overflow rooms; yes, the crowd was unusually dense and almost swarm-like, but these attendees have been like that for some years now since 9/11, 2001. The European meeting is now one of the largest cardiac meetings in the world, overtaking the American meetings, since 9/11. The reasons are many, but perhaps the chief of which is the immigration hassle, and the intense scrutiny of 'aliens' from so-called 'mistrusted' nations; the second is indisputably the greater distance to travel for most around the world. I sense that over the past 10+ years or so, America's foreign policies have taken a toll on its possibly declining image as a friendly, welcoming, respected or admired nation...

Most times, such medical conferences, is a one-way learning process for most participants. But latterly, the lectures, seminars or forums and teaching styles have been geared toward comprehensive, practical details of bench or clinical management and diagnostic choices based on research evidence, which are constantly being updated, replenished and unearthed! 

(The new 3rd universal definition of myocardial infarction and injury is one case in point which was carefully detailed and expounded over several sessions to push through the concept of accuracy and consistency of the definition so as to strengthen what each and everyone of of us mean by simply just that - Myocardial infarction, from the classic type 1 through 4b, etc. Hotline sessions identify late-breaking studies which either prove or disprove perviously hypothesized ideas and studies, etc...) 

Yes, it is true that one can never hope to attend all or even a sizable fraction of the huge number (more than 3500!) of lectures, presentations or poster sessions. But for those who do turn up, most, I think feel they need to find relevance and best value of their attendance. Arguably these learning experiences might or could have been better perused at home via the internet and journals, according to some detractors... 

But there are some 'benefits' for those who make the best use of the limited time there at any conference! Firstly, for a delegate to fully participate, I would argue that he or she should ideally be relatively well-versed and current. There is little place if any for the novice (or the medical student, unless he or she is participating in some relevant research study, etc. when these would have its narrowly focused but very constrained benefit, from my viewpoint), unless of course this is purely as an initiating learning experience to enthuse the young into the scientific culture of research work and presentation...  

Some would of course argue that even for the less initiated e.g. unrelated physicians from other disciplines or allied health practitioners, many of these more detailed lectures could be difficult, but nevertheless useful for comprehensiveness in the team approach to clinical work these days.

Nonetheless for many, some of the more esoteric and state-of-the-art lectures would or could be incomprehensible, and be out of his/her league--such are the tremendous advances and rapidity of new knowledge (of course, not all of these new hypotheses and theories are persistently relevant or ratifiable, with many falling by the wayside, with time, experience and new studies--such is the nature of scientific method!) 

What is really useful is listening to some of the very good teaching lectures and overviews from the experts' horses' mouth literally! The ensuing debates and questions that follow are also eye-opening and often tease the subtle nuances out of the more challenging concepts; these underline the extensive if somewhat chaotic if sporadic expectations and extracted relevance of the talks or opinions. The structure nowadays is to have closely related lectures 'repeated' with slight variations and from different practical angles, so that one can catch up with the most important changes and developments of the year in their chosen special field--yes all can really be gleaned and learnt within a short few days with direct access to most of the experts (there were many meet-the-expert or investigators sessions)--a fantastic networking learning experience, especially for busy clinical physicians! 

Contrary to the argument that some of the talks might be too esoteric and theoretical -- practical points are always highlighted and emphasised, so to each, his or her own take... At end-of-day sessions and particularly the final half day, the most important learning points are summarised by experts, once again for those who bother to stay the tiring course! I was there from around 8 am to around 6pm daily, with hardly a break for lunch, where there are lunch-box sessions (usually industry or medical establishment sponsored--but centred around new findings and research, e.g. good sessions from the Cleveland and Mayo clinics), and also evening sessions (also usually revision focussed symposia) which I chose not to attend, bar one, that I felt would be relevant and useful to my practice, until 8pm (by then, I was physically and mentally exhausted!). 

In younger days, when I was presenting a paper or a poster, I remember the exciting rush of anxious but satisfying glow that perfused my being, of having been a 'true' participant. But when I think back of the relevance or practical significance of my research and studies then, one becomes humbled by the fact that most, if not all of these have become insignificant or even proven unimportant. A few were confirmed by even more elegant and better refined studies--e.g. my winning paper in the YIA ASEAN Congress of Cardiology in 1990 on 'cardiac autonomic dysfunction in diabetes' is one particularly memorable paper... This had led to its publication in the Singapore Medical Journal then. 

So for young researchers and doctors, don't lose hope and carry on dreaming and working on hypothesis-generating ideas and studies, which will continue to be the way science finds its meandering relevance and significance! Of course, in the spread of time, few research studies truly meet their universality of relevance or stand their values... most research serve as stepping stones to better ideas fully ratifiable and continually being challenged--such is the scientific method. Most studies perhaps in excess of 99.99% will fall away and become bumpf, irretrievably forgotten in the museum of lost books and publications...

These days, I am periodically called to chair some sessions, or to to be invited to give some review talks or teaching a workshop which makes relevance my take on being a medical educator and a proctor of sorts. I still go for smaller teach-ins for new pharmaceuticals and techniques, because these actually enhance my practice, my confidence that I am doing the correct thing, the up-to-date and arguably the best evidenced practice that I can muster...

And finally, because I am a delegate, I am privy to the full journal papers (some of the lecture slides) many of which are simultaneously published around this time, and which reinforce the learning experience very well! 

I suppose all that I have stated could have been learnt and experienced from simply reading journals, and reports, discussions, presentations online, but I doubt if anyone has the consistent discipline or the focus to do this on a concerted period of a few short days... I know I am too distracted by my daily humdrum noise of work and more work, which distract my attention too frequently... 

Of course I get to go away a short while (a time-out literally!), stay focused on still being interested in relearning new basic science advances esp. gene-based approaches to cardiovascular therapeutics; evidence-based, clinically relevant learning and sharpening my pharmaco-therapeutic and interventional 'skills', etc... 

Perhaps I still managed to steal some evening moments enjoying some beers, schnitzels, apple crumbles, sauerkraut and pork knuckles, networking with like-minded colleagues from within our Malaysian shores or abroad.... 

This trip, I got acquainted with a few of our dynamic younger generation cardiologists: Drs TK Ong, Alan Fong, and other bright young Masters and PhD researchers from Kuching Sarawak, who inspired me no end with their zest and enthusiasm. (There was a special international programme for Cardiologists of Tomorrow, one young Malaysian cardiologist participated.) I hope I'd managed to share my own experience, to inspire and encourage them to persevere in their trying frustrating atmosphere of lack of or low support and research funding, even allowances and remuneration, and to instill in them the need to further the cause of scientific adventure and research for Malaysia! 

Yes, for me it was 'that' useful and meaningful, and I returned, re-charged to hopefully do better, work better! Perhaps, I'd narrowly escaped another possible burnt-out phenomenon so rampant among so many of us.... I am determined that life's work is still not done, and I have a few remaining small but worthwhile parts to play, still!