Leaders in Medical Education

Dr. Jonas de Jong, Founder and Chair of CardioNetworks

Osmosis Team
Aug 31, 2016

Dr. Jonas de Jong is a cardiologist and electrophysiologist based in the Netherlands. Dr. de Jong received his medical degree from the Universiteit van Amsterdam and completed both his cardiology residency and electrophysiology fellowship at the AMC. Dr. de Jong is also the founder and Chair of CardioNetworks, a non-profit organization founded in 2007 and based in The Netherlands.

The goals of the Foundation are: “to improve medical knowledge, especially in the field of cardiology, and to provide access to this knowledge by facilitating publications in digital or other form, amongst other means by building and maintaining websites.”In addition to CardioNetworks, Dr. de Jong serves as a reviewer for various scientific journals, including the Annals of Internal Medicine, Heart Rhythm and the International Journal of Cardiology.

How did you decide on a career in medicine?
I come from a family of doctors, but in high school I was more oriented towards a more scientific study. In primary school I was passionate about electronics and I started programming when I was twelve. In the end I started to study physics, but after one year switched to medicine. Medicine was more attractive as the fellow students were better company and the idea that you can make a positive change in someone’s live every day of work was ultimately appealing.

What factored into your decision to specialize in cardiology and specifically electrophysiology?
During my electives I switched plans a couple of times, but cardiology was my final elective. Working there I found out that it to be the best specialty ever: making your diagnoses with your own tools (ECG), doing your own imaging (echo / angiography) and having the treatments in you own hands (ablation, pacemaker, intervention). Electrophysiology was a natural combination of my ‘old’ hunger for technology combined with the possibility to improve patients life.

What was/were the most memorable experience(s) during your medical education?
Of course there were many memorable experiences, each important in it’s own way. I remember a patient dying of a main stem occlusion just before the first incision for a bowel operation. The fact that sometimes a patient dies suddenly, although you tried everything to assess sudden death risks is a very real part of cardiology.

How is the European medical education system different from that in the United States?
There are many differences. We start with medical school at age 18 (there is no college in between). This makes the student population quite a bit younger. Grades are less important and there is much emphasis on extracurricular experiences. Medical school is ‘free’ (about US$2000 per year), so average students have only small debts when they finish. After obtaining your MD title, you apply for a specialty such as cardiology directly. A PhD (4 years) before your specialty training is highly valued and increases your chances of getting in.

What was the inspiration behind CardioNetworks and how did you translate the idea into reality? What were your goals in starting the non-profit organization?
It started in 2002 when I was teaching medical students while al the beginning of my cardiology training. I created a website to have the images at hand that I was drawing repetitively. During this time Wikipedia and Mediawiki (the software behind Wikipedia) were just out. As I saw more and more web traffic to my ECG pages, I started ecgpedia.org. As traffic to ECGpedia grew, I wanted to make it less depending on me personally and founded CardioNetworks with a couple of friends so there was a stronger backbone organization to the websites. As I already have a salary as a doctor, I didn’t find it necessary to make it for profit. Also, the non-profit model is much easier to maintain as we need only minimal funding to stay alive. During recent economic crisis years funding has been difficult to obtain. I am convinced that if we would have chosen a for-profit model we would have been bankrupt by now.

What future directions or growth objectives do you hope to achieve with CardioNetworks?
I frequently monitor web traffic to the different web sites we maintain. We try to channel funds towards developing the web sites and pages that attract most traffic, so we spend our energy on content that has a real demand. There are many things on our ‘whishlist’, but with the busy lives of our board, it is not realistic that we will accomplish them shortly. Our main goal is to provide the number 1 websites in the specific field (e.g. ECG education) and to have a sustainable model that lasts > 5 years (as it has been in the last 10 years.

How can professionals in the medical field communicate more fluently and better share information with each other while keeping in mind patient privacy?
I live and work in a very different judicial system than the US. Good and fast communication between doctors can save lives, whereas it is hard to think of a situation where leakage of medical information can cost a live. I think believes about privacy result in laws that cost lives. Healthy people often care about privacy in a completely different way than patients do and still healthy people make the laws that affect patients. I have yet to meet a patient that had privacy concerns when they (e.g.) use e-mail to contact me. The ups of fast communication weigh much more than the potential downs. Also, there is often debate about the safety of e-mail, but people forget that the alternatives have similar security issues.

For cardiology: ECG’s and echo’s (when anonymized) are not considered to be privacy sensitive images and I think it’s OK to share these with ‘unsafe’ messaging such as WhatsApp when on call or for educational purposes. Several safer messaging systems are under development, such as Siilo which will make this easier from a legal point of view.

What would you like to change about medical education presently or medical information sharing that could ultimately streamline medical care?
Evidence based clinical knowledge should be the basis. Google can not replace a thorough basic fact knowledge. In clinical practice you simply don’t have the time to do internet searches all the time. Training should also spend time specifically on the rare diagnoses that you will miss if you don’t recognize them. Digital tools can help to train recognizing abnormalities in physical examination, but can never replace patient contact.

Testing is a perfect way to ascertain a minimal level of knowledge before you continue with next steps in training.

Many aspects of medicine are consistent worldwide. Online Coursera like tools could be a good way to build ‘international best practice’ courses for basic subjects such as physiology, ECG, biochemistry, pharmacology etc. A model where resources can be gathered to develop high quality medical education tools is currently missing.

While progressing through MD training it would be useful to use test information to detect lacks in knowledge with an ‘action cycle’ à discover missing knowledge à feed individualized bits of knowledge à retest.

Big data mining of Epic is currently used to optimize financial figures, but could also be excellent way for scientific research into optimalization of diagnostic steps and care.

Many ideas of ‘Watson’ style diagnostic aides that have been around for > 20 years are far from being used in daily medicine. Actually a lot of what we do is not ‘House’ style MD/ medical detective work but routine daily care. Reducing healthcare burden for patients in number of procedures / doctor visits / diagnostic tests should be part of training as well.