Dr. Ariel Farkash

A few words from our most recent visiting Rabin Medical Exchange Fellow, Dr. Ariel Farkash!

The Rabin Medical Exchange Fellows Program sponsors Israeli doctors from the Rabin Medical Center to visit at premiere medical institutions in the United States for periods of two weeks to one year. Thanks to funding from our outstanding donors, the fellows are provided with the unique opportunity to engage in specialization, research, training, and education projects during his/her observation period.

AFRMC’s recently welcomed our newest Rabin Medical Exchange Fellow, Dr. Ariel Farkash. Dr. Farkash arrived on June 1st in New York for a one month stay at the Department of Cardiothoracic Surgery at Mount Sinai Hospital in New York. During his stay he was able to observe the work with Dr. David Adams, an international expert in the field of heart valve repair.

Read more about Dr. Farkash’s fellow exchange experience below!

1. Provide an overview of your fellowship at your hospital and the role you played during your stay.
I was an observer in the department for Cardiothoracic Surgery in Mount Sinai Hospital. This department is lead by Dr. David Adams who is one of the leading surgeons in the field of Mitral Valve Repair. Instead of replacing a leaking valve, (thus leaving the patient with a prosthesis valve with all its complications) , he fixes it, thus letting the patient stay with his own native valve and natural physiology. I also observed Dr. Paul Stelzer, world renowned in the field of aorta surgery. During that time I was exposed to LVAD implantation and heart transplantation. Additionally, I visited Columbia Medical Center/NYPresbyterian Hospital - observing congenital cardiac surgeries performed by Department chief, Dr. Emile Bacha while also becoming familiar with the hospital’s faculty and ward.

2. Describe how your fellowship opportunity has expanded your knowledge in your specific field.
As a resident, it is technically difficult to be exposed to mitral valve surgery - valve replacement and specially repair. This experience allowed me to be exposed to the general approach to mitral valve, anatomy, physiology, decision making and surgery. As well, I learned several techniques in aorta surgery, in the precision and meticulous surgery it requires.

3. What did you enjoy most about your fellowship opportunity?
I really enjoyed the freedom to focus solely on the surgical aspect of my training. Spending all my time in the O.R enabled me to see much more in a short period of time. It allowed me to focus and become deeply familiar with the specific subject of Cardiothoracic Surgery, living it in a way that taught the principals of the specific field. Also, being able to meet and watch great cardiac surgeons was a unique and inspiring experience.

4. What were some of the challenges you faced while working at your hospital?
It was challenging to become adapted to the different working methods, and to understand the relationships between all professionals.

5. What do you think is the significance of international medical relationships and fellowship programs in regards to the future of medicine and research?
This kind of program provided me a window to see how medicine works in another medical institution. This experience expanded my mind and thought process to new ways of thinking and working. For example, many medical techniques I was taught were mandatory for successful operations, however, in this NY setting I learned to see that they are not always necessary. I gained insight to the way things should work, and saw weaknesses as well as strengths of the Israeli system in which I grew up as compared to the American system. Meeting professionals in my field, not only American but also foreign fellows, provided new opportunities for future cooperation in the clinical and research world.

6. Explain the major differences between the Israeli health care system and the United States private healthcare systems in terms of your specific field.
As a resident in the largest cardiac surgery center in Israel, I was proud to see that there is basically no surgical procedure I have not been exposed to. On the other hand, there are two big differences between the US and Israeli health care system: The first isthe volume of cases - a crucial factor in developing expertise in perfecting ones surgical skills. For example, Mount Sinai’s Dr. Adams performs in one week the amount of valve repairs an average Israeli surgeon performs in a year, thus making him among the best surgeons in the world in that field of expertise and enables everyone around him to learn much more about this kind of operation.
The second factor is: resources - the availability of advanced technology, enables the usage of assisting technologies in almost every operation aiding the achievement of better results. Availability of manpower in every level of medical care enables the surgeons to focus only on improving their surgical skills and performing research. The presence of additional skilled "physician assistant" in the O.R, provides greater possibilities for the senior surgeons to teach and give attention to the young residents, in that way helping them develop his/her surgical independence gradually.

7. What do you feel are the key issues and challenges in your field - not only in the Unites States and Israel, but worldwide?
The biggest challenge in the world of cardiac surgery is facing the competition from new and less invasive technologies that threaten to take over most surgical procedures. The way to stay relevant more than ever, is by achieving better results compared to other techniques and developing minimal invasive surgical techniques that are not inferior to traditional surgery. The improvement of technology allows us to do just that - better surgical tools and understanding of cardiac physiology allows, for example, better heart-lung bypass machines, minimal invasive operations (CABG and valve) etc. Another path that allow today's surgeons to fit in the future surgical world is surgeons taking part in some percutaneous procedures (such as trans apical valve implantation), this process is already at its peak at Columbia Medical Center. Also, the world of mechanical assist devices that broke into the mainstay of treating heart failure patients is unique to cardiac surgery.

8. What are your future plans at Rabin Medical Center when you return to Israel?
I am in my final year of residency. I hope to graduate from my program in the next year while using tools I took from that experience. After my graduation, I plan to come to NY for a full two year fellowship program. I hope to achieve that thanks to the people I've met and interviews I performed during my recent fellowship at Mount Sinai Hospital.

9. What is the main lesson you will promote to your fellow colleagues upon your return to RMC from your stay in the US?
Since returning to Rabin Medical Center I have already talked to my fellow colleagues about the many issues I encountered in my visit. Some of the thoughts and lessons are mentioned above, but definitely what I take from my experience is the importance of going for a period of time to visit and explore such medical centers overseas. Such experiences indeed influence a medical professional’s life in many aspects, by expanding my professional horizon, meeting colleagues, and learning new techniques of the cardiac field.

Thanks to the American Friends of Rabin Medical Center for an invaluable and once in a lifetime experience!

Dr. Ariel Farkash
Rabin Medical Exchange Fellow
Cardiothoracic Surgery, Mount Sinai Hospital