Professor Špaček: I have helped dozens of doctors prepare for their board certification, and I am proud of that
Professor Rudolf Špaček is a renowned cardiologist and head of the Internal Medicine Department at Na Františku Hospital. In July, he was awarded a silver medal by the Scientific Council of Charles University for his many years of scientific and teaching work. Among other things, he requires his students to maintain a professional and ethical approach. “I’m simply old school, and there’s no changing that now,” says the doctor, who was there in the 1990s at the birth of a completely new system of care for heart attack patients.
Why did you choose cardiology out of all the medical specialties? What attracted you to it?
I decided on cardiology while I was still a medical student. Especially at the beginning of my medical studies, I was mainly drawn to the fast-paced nature of this field. It’s not quite the kind of calm medical practice one might expect from other internal medicine specialties. In cardiology, we often deal with rapid changes in a patient’s condition, and we have to get hands-on. Back then, I was interested in implanting pacemakers, central lines—basically, various invasive procedures. But I didn’t want to be a surgeon, even though I’d already completed surgical rotations in high school. Just performing surgeries wouldn’t have been my thing. In contrast, internal medicine is a broader field and, I would say, even more complex. As a medical student, I rode in the so-called mobile coronary unit, which was a vehicle belonging to Vinohrady Hospital that served patients with sudden cardiac problems throughout Prague. That was a great learning experience for me. In patients’ homes, during transport, and later in the coronary care unit, I learned diagnostics, cardiopulmonary resuscitation, central line insertion, and similar skills.
How much has cardiology advanced in the nearly forty years you’ve been working in the field?
Enormously. When I started in the 1980s, it was a completely different era. IKEM was the only facility in Prague performing heart surgery, catheterization procedures were rarely performed, and there were very few medications that affected the cardiovascular system.
And how were heart attacks actually treated back then?
Essentially, with several weeks of bed rest. Patients weren’t even given basic medications like aspirin or heparin, which, as we know today, have been proven to reduce mortality in these patients. Since the mid-1980s, however, the treatment of heart attacks has undergone rapid development. One of the facilities that began performing modern invasive examinations and procedures, such as catheterization and angioplasty, was the Vinohrady Hospital, where I worked. In the 1990s, a nationwide network of cardiac centers was established, thanks to which a patient experiencing chest pain and suspected of having a heart attack can reach the catheterization lab in a very short time. This model, whose implementation was initiated primarily by Professor Widimský and his team—of which I was a part—has received numerous awards and remains a model for essentially the entire world to this day. Scientific studies I worked on showed that it is far better to transport a patient to a cardiac center and perform angioplasty than to dissolve a clot in the coronary artery on-site with medication.
In addition to treating cardiovascular diseases, you also specialize in internal medicine in general and pass on your knowledge and experience to students. Can you tell us how you actually got into teaching medical students? And has anything changed since you first started?
Of course, there have been certain developments in this field as well. During my student years and the few years following graduation, it was a truly prestigious honor when the department chair allowed someone to teach. Back then, only doctors with a CSc. degree—which is today’s Ph.D.—and two board certifications were allowed to teach. However, our department chair at the time, Associate Professor Strejček, allowed me to supervise internships and teach medical students after my first certification, which was a source of some envy among certain colleagues. Today, it’s more the opposite. Doctors have plenty of other work, and few are willing to take on medical students.
But you enjoyed working with medical students…
Yes. It can be said that I have been teaching students at the medical faculties of Charles University continuously since 1983, through seminars, lectures, and clinical rotations. Around the mid-1990s, I was also appointed to the examination board for the state final exams in internal medicine.
I hear there’s a lot of interest in internships in your department.
I’m not sure why, but there’s so much interest that I can’t even accept everyone who applies. We get fourth-, fifth-, and sixth-year students from all three medical schools in Prague, and there are several medical students in our internal medicine department every day.
Do you have any idea why students like it so much here?
That’s a question best directed at the medical students themselves, but they seem to appreciate our approach, which I’d describe as fairly liberal. We give students a certain amount of freedom to choose what they want to see and what interests them. At the same time, they can learn a great deal. For example, they go through the central triage of unsorted patients brought in by ambulances, experience their first contact with a patient, learn what is done with them, how they are examined, and where they are sent next. They’ll get a look at gastroenterology, diabetology, or perhaps echocardiography. According to them, they see a lot here, and it’s beneficial for them. So I hope they’re telling the truth.
In addition, you’ve also been successful in preparing young doctors for their board certification exams. Is that right?
That’s true. If there’s one thing I can be proud of, it’s the fact that over the past 14 years I’ve worked at Na Františku Hospital, roughly 25–30 doctors have passed through my department after graduation, and I’ve prepared them to obtain the so-called “internal core” certification, which replaced the former first certification. Another 12 or so doctors under my supervision also passed the specialization certification in internal medicine—the original second certification—and four doctors went on to complete the advanced certification in gastroenterology so they could perform invasive gastroenterological procedures. I’d say that an average of two certified doctors per year is a pretty good success rate for a mentor.
You must truly enjoy working with students and young doctors, judging by the enthusiasm with which you speak about it.
Of course, although it can sometimes be challenging to balance all my professional responsibilities. At František Hospital, I focus primarily on patients, and I’m not only responsible for the entire internal medicine department but also serve as the deputy director for curative and preventive care, so I handle matters concerning the entire hospital. On top of that, I’m in charge of medical students and physician training. But if I didn’t enjoy it, I wouldn’t be doing it.
Do you consider yourself a strict boss?
Yes. But you know, even though a lot has changed in medicine in the forty years I’ve been in the field, I’m still old-school in certain respects. Working at the bedside leaves its mark on a person. When it comes to my relationship with patients and their relatives, I have certain ingrained ethical standards that I’m no longer able to change. For example, I place emphasis on how young doctors dress, how they treat patients and their relatives, and how they conduct themselves. I don’t like it when a medical student comes for an internship wearing shorts, a grubby white coat, braided hair, and an earring. Some might consider that discrimination, but I’ll send them home. I know what I’m talking about. After all, I experienced this firsthand as a patient when I was bedridden myself. So I require a certain standard of behavior and demeanor from both medical students and doctors. A doctor simply has to look like a doctor.
Prof. Rudolf Špaček, MD, PhD, head of the Internal Medicine Department at Na Františku Hospital, received an award from the Scientific Council of Charles University for his significant contributions to the field of cardiology and his long-standing scientific work.
You can read the full article on the UK website.
