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Dr. Amor, you are Founder and Chief Medical Editor of www.incathlab.com, an e-learning platform for physicians and practitioners that, by the meanwhile, well-evolved and offers a great range of video cases on the field of interventional cardiology and radiology documenting basic up to complicated treatments and operations.

• What was the occasion and what were the motivating drivers for you to start Incathlab?

I started in the 90s to organize courses with live demonstrations. In 2002 we produced registered cases on CDs and distributed them after a meeting. However, these registered cases have not been captured through a camera. The streaming slowly started in 2009 and had to be further elaborated. Later we decided to try live cases in a different way, in terms of registering a case and streaming it directly from the cathlab which was rather experimental. As a very historical date, on 12.12.2010, we blocked all the cathlabs of the Clinique Louis Pasteur in Nancy, and put everything happening during that day on the internet. The idea matured in 2005 through the movie “A Day in Nancy” and we transformed it into “A Day in the Cathlab of Nancy”. This has been a great opportunity to enter the intimacy of a hospital. Technically, everything has been possible, even to follow this historical moment on your iPad or computer. However, the sound was not yet elaborated, it was somehow correct and what was counting was the final product.

Following, we adopted the concept of a web symposium from an excellent center asking it to choose a maximum of cases during 2 days. Capturing the center through cameras and showing it on the internet is an opportunity to test and investigate its system in seven or eight cases. As a side effect, it enabled us to fill the library very quickly. The real web symposium has been started in September 2011; it took us nine month to get ready on track, hence, we launched the website at the end of 2011.

We are in a discipline where it is important to learn with and from a partner and teacher. This can be compared with a craftsman, you have to have a trainee that looks at the technique and tries to follow and a master that tells him exactly what is not taken out correctly – the process of practicing and learning is vital. everything we are aiming at is to enable a practical access to this learning system. You can compare it with music, you write something, but it does not convey the sound of the music and you don’t have a feeling for whether this composition is good or bad. In our case it is important to watch; on Incathlab you can watch the various cases several times until you understand it. You can even see it as a rehearsal. It is a very convenient way to learn and practice and improve your skills. For us it is important to produce real learning objectives. Here, it is my responsibility to guarantee content in its honesty. Visitors even can make use of the opportunity to share their positive or negative opinion with us. We are advising visitors on techniques. This is a platform of give and take, of exchange. I, personally, don’t support the top-down learning approach. Learning should take place on a collaborative level.

• What makes Incathlab so interesting and unique?

Incathlab owns the largest library in cardiovascular techniques; nowhere else one can find a comparative collection of more than 400 cases. Today it is the most complete library of endovascular techniques. We are building the coronary video cases step by step and the people showing their cases are top experts in their field. Visitors can follow several good practices from centers and experts; they cannot only watch one radial stenting, but may compare techniques and find their own best practice to the approach. This is what makes Incathlab unique. There are cases of abdominal aneurism in different settings. The system combines the idea of an e-learning platform and a TV channel. We also try to add entertaining aspects to the platform and to make the website more appealing to the audience with the help of a great IT team. Comparing the sessions produced in September 2011 with the sessions captured today, there are worlds in between and this has been achieved in less than three years and it keeps changing and progressing. Furthermore, it is a European platform that is constantly improving.

• Where do you get the ideas for video cases from? How do you usually proceed when deciding for an interesting video case for Incathlab? Do you think of a case and select a patient accordingly or do you encounter a patient with an interesting case and following decide to shoot the treatment for Incathlab?

Video cases came from my history of live cases. Just by seeing live cases, they are not stored in your memory, that’s why I had the idea to capture them. We had pathologies that were infrequent, it is better to capture the live sessions for later review. Now we are following the technological advances. With the help of our developers, we are trying to make the system more user-friendly and collaborative.                                                                                           What is vital is to select a subject and a center as the base. We are coming to your center for two days and we are shooting some cases. Furthermore, we are also open to shoot interesting cases from another pathology or territory taking place within these two days. This is an added-value to the library and we are more than happy to integrate them to make Incathlab more vivid.

• What do you think is the hardest case you have ever taken and shown on Incathlab? Why was this specifically difficult?

There are plenty of cases that are very difficult. I would compare us with acrobats. The day you are starting to perform very difficult acrobatics, deciding to go on a wire from this building over to that, it becomes difficult by itself. We ask people to do cases, but from time to time people themselves play the acrobat, so the cases itself are very difficult. Probably among six or eight cases there is at least one acrobatic case. There are always exceptional cases that visitors can watch on Incathlab. There are cases that doctors try to solve in four hours; that is why the content is very important as well as our team that is in charge of editing the videos.

• The fact that there is a camera capturing your case while you are taking out a treatment, is it changing the situation, are you acting differently or more consciously?

No, not at all. We never see the cameras as we are surrounded by remote cameras and not by a camera operator. The atmosphere does not change and the situation stays very natural.

• Have there been any cases that remained unsolved and do you feel bad if cases remain unsolved?

We try to be very sincere and honest. Visitors can find a lot of cases which remain unsolved, cases that we started, however, could not finish as well as cases in which we encountered complications. It is important to show them. Incathlab is a learning platform and not an advertising website. It is significant to show the audience that trained operators and experts are not failure-free and need to stop the treatment in order to prevent injuries of the patient.

• What are the rewards for you in your work for Incathlab?

It is incredible to see the audience that is using the system. The last time I was in London for the Charing Cross Conference, while chairing the session of Abbott, I received questions from Azerbaijan, Japan and many more countries farther away and I realized the very global network behind Incathlab and being part of a session streamed to all parts of the world. It was a very moving feeling. I strongly believe that this is going to be the way of teaching in the future, a universal teaching tool. Incathlab is still in the very beginning of its being, however, the principle is there and well implemented. Another important fact is that Incathlab is very nostalgic. For me, personally, it is important how ideas are progressing and where they are coming from. In medicine and operating techniques, it is important to understand who you are and in which phase of your life you are. Of course, we missed capturing a case with Andreas Grüntzig, the inventor of the balloon angioplasty. However, I am very happy that there is one video with Klaus Mathias, the inventor of Carotid Stenting, he retired in June 2013. This is a very historical event as people can admire a video in which Klaus Matthias is working. It also gives an inside in the technology years ago and modern technology in order to assess the advances that have being made recently; this is also a progression of our ideas.

• Experts from the cardiological field are invited to contribute to Incathlab, what qualifications are needed to become a contributor?

A contributor is supposed to be an expert, someone that is well-known in this pathology and specialist of a particular device, the credibility of an expert is of high significance, otherwise our visitors might question Incathlab. 

• Why is it so important for you to attract further contributors to join Incathlab?

There are excellent ideas, that focus on one country, however, are not spread efficiently and I realized that even in the times of the internet, ideas are not distributed efficiently and it takes years that they become public. We try to speed up the diffusion as it is essential for the medical field, in particular, for the health of the patient. Hence, further contributors joining means, further fresh ideas for Incathlab and interventional cardiology and radiology. Ideas have to be made available for the reason to advance medicine. For instance, today we are talking about the Szabo-Technique, a guide-wire technique, very tricky, already invented in 2005 and still in 2013, it is barely made use of it. I see our role also in promoting ideas and advancements in medical techniques in order to use it more frequently for the safety of the patient. We also want to show, that ideas are not exclusively from the United States, but from Europe, from Germany, Slovenia etc. We are proud to promote Indian specialists providing their cases, as they are very good in terms of techniques. It is of high significance to keep track of the advancement in the whole world as we can learn from each other for the benefit of the patient.

• Do you have any advice for young physicians and practitioners?

It is important when taking out a technique to have a mentor and to learn from him. On Incathlab, visitors have several mentors. And even if a center wants to present a technique, we from Incathlab try to shorten the time of its publication. Normally, publishing a paper, its take usually up to three years after approval to be published. We are speeding up the process to four to five months, we are open to new ideas, Incathlab as a platform for exchanging ideas of techniques become alive by new ideas. In this regards, we use to call it video publication, which becomes more and more important instead of writing a publication. Especially for young physicians it is important, when returning home to work on a case and go back and finally understand the steps within a technique.

Regarding practitioners, meaning someone that is more experienced, they have to criticize themselves, does another one do it better and should I maybe rethink and adapt my practice and technique.

• What is your personal aim in the scope of Incathlab? How do you wish to see Incathlab in the future? Are there further projects for Incathlab’s development envisaged?

My personal aim is to see Incathlab as a complete e-learning channel of cardiovascular operating techniques. Complete means that it should combine all techniques that are necessary in practice and incorporate all information of a technique. Hence, this e-learning platform has a moving target as new techniques are appearing on the market, old ones are disappearing; hence, it has to be progressively maintained.