The Vascular Forum Project: democratizing medical knowledge
*Prof. Dr. Alexandre Campos Moraes Amato, PhD in Sciences from FM-USP (University of São Paulo); Professor of Vascular Surgery at UNISA (Santo Amaro University); Vascular Surgeon, Endovascular Surgeon and Vascular Ultrasonographer certified by AMB, SBACV (Brazilian Society of Angiology and Vascular Surgery) and CBR (Brazilian College of Radiology); TCBC General Surgeon by CBC (Brazilian College of Surgeons); MBA in Health Management from FGV
*Dr. Fabiano Luiz Erzinger, Master of Surgery from the Federal University of Paraná (UFPR); Full Member of SBACV; Vascular and Endovascular Surgeon at the Instituto da Circulação in Curitiba, PR
*Dr. Walter Jr. Boim de Araujo, Master and PhD in Surgery from the Federal University of Paraná (UFPR); Full Member of SBACV and SOBRICE; Angioradiologist and Endovascular Surgeon at the Hospital de Clínicas of UFPR; Vascular Surgeon, Endovascular Surgeon, Vascular Ultrasonographer and Interventional Radiologist at the Instituto da Circulação in Curitiba, PR
The Vascular Forum Project began unpretentiously. It was not even a project. It was never planned. There were local groups. Journal clubs and departmental meetings, which, although they had sustained the continuing education of physicians for decades (perhaps centuries), had a serious and, until then, insoluble problem: the addiction to a closed pool of information, only sporadic exchange with outside groups, and the recycling of internal ideas, without the crossbreeding of the DNA of ideas. Just as in genetics, the crossing of internal ideas is far less powerful than crossing with external ones. Some groups isolated themselves deliberately; others were isolated by circumstance. Still other physicians, geographically isolated, did not even have the opportunity to exchange experiences.
Exactly 50 years ago the internet was born. An essential tool for facilitating communication between people. Online groups, from BBSs (Bulletin Board Systems), evolved into IRC and then into forums on websites. Looking back, we realize that medicine always had a latent need for the exchange of information, with several attempts to form groups. At one point we came across a book that drew a great deal of attention: "The 100 questions of the vascular cyber forum." Briefly, since some here may not have had the chance to know it, it was written by Dr. Bonno Van Bellen, as the materialization in book form of a discussion group created by an e-mail list during the early days of the internet. We found it very interesting. With the only resource they had at the time (an e-mail list), they managed to bring together several renowned colleagues as well as everyday practitioners from various regions of the country and even the world, and to create great discussions grounding an interesting form of learning, through clinical cases and in real time. But the world was not ready for such an exchange of information. Legal issues drove the forum to extinction.
A group of physician friends, vascular surgeons, close in ideas but far apart in physical distance, troubled by the traditional one-way flow of information at conventional congresses and events, felt the need to hold more "down-to-earth" discussions, with two-way exchanges, with professionals who faced the real day-to-day of the specialty, above all without grandstanding and without the influence of industry on the opinions they expressed. As real-world surgeons, we know the infrastructure difficulties in our country; we know the real difficulties of someone still struggling to have a vein stripper approved while, at congresses, only thermal ablation is discussed. This kind of discussion does not make it into a congress showcase, but the solution adopted in one corner of Brazil may help in another. Consider the recent rapid dissemination of polidocanol foam. Once restricted to a few services, it quickly achieved wide adoption.
Now the moment was ripe and everything was easier; the internet had already advanced greatly and social networks were beginning. On that occasion we also came into contact with a now-defunct Endovascular Forum (which was very good, though not entirely free of industry influence). It would take the arrival and spread of Facebook, with the standardization of a forum requiring no technical knowledge. At that point we created the Vascular Forum on Facebook, which, though also very interesting, especially at the start, raised a few concerns for us, the main one being the very large proportion of members (today it has 2,692 members) on a platform where the virtual is very strong, allowing even for fake profiles. With this came, above all, the legal concern, with the exposure of cases without authorization and the inclusion of fake profiles of non-physicians.
With the emergence of WhatsApp, it seemed that many things could improve. The profile was trustworthy, showing the colleague’s own telephone number. We had groups formed only of specialist physicians, giving us greater legal protection, since this kind of case discussion among colleagues is permitted by current legislation, and the two-way security that WhatsApp offered. But we were concerned about the invasion of each person’s personal privacy, in the sense that messages entered one’s personal phone, at a time when such intrusion is already very pervasive. In that period we went so far as to create the Forum group and cancel it at least twice, until, at the colleagues’ insistence, we decided to keep it in the form it has today.
After the Forum group on WhatsApp began to gain members, we noticed the constant flow of information, ideas and, consequently, case reports. Anyone who had a doubt, a curiosity, or an interesting case would post it and receive, almost instantly, a peer review. Interested peers, unencumbered by commercial interests. Genuine personal opinions. Today, on WhatsApp, we have: four groups for General Vascular Clinical Cases, three for Ultrasound-Guided Foam, two for Transdermal Laser, one for Venous Thermal Ablation, one for Transplant and Access, one for Vascular Faculty, one for Vascular Fees, and one Social Vascular Forum, totaling around 2,100 members.
The line was drawn. A line of excellence. In the obscurity of isolation, with no one to exchange experiences with, there is no incentive to improve, no comparisons, and sometimes we need to reinvent the wheel that has already been invented elsewhere. There are no longer any barriers to the exchange of information. There is no room for those who "withhold information." There is no room for those whose ego does not allow them to learn from others. Everyone has something to teach and something to learn. Seeing positive experiences and colleagues with similar difficulties solving problems with the inventiveness characteristic of our culture, we realized that everyone had begun to use the forum for personal and professional development. Raising the excellence of the specialty in our country. Sometimes, the mere mention of a rare disease triggers a literature review and a deeper look into obscure but extremely useful questions in practice. And so a tool of communication was transformed into an excellent tool for teaching and continuing education. Self-sustaining. And with a life of its own.
We can say, with complete confidence, that we have learned more in the WhatsApp Forum groups than in any textbook in recent years. But beyond that, we have made friends, both virtual and real. Friends who share a vision of life that our specialty has given us.
Vascular Forum on Facebook: https://www.facebook.com/groups/forumvascular/
Vascular Forum on Telegram: http://bit.ly/forumvascular
