Research has shown that the practicum experience for professional preparation students in physical education teacher education programs related to teaching youth with disabilities can improve self-efficacy. It is not currently known if a virtual program can be effective for the professional preparation students or the participants. The objective of this study was to determine the experiences of the participants of a three-month virtual practicum program. In this phenomenological study, thirty youth with visual impairments and 1:1 professional preparation students (coaches) took part in a three-month virtual physical activity program. A total of 11 coaches took part in 2 focus groups, and 10 of the participants were interviewed about their experiences in this unique practicum. Findings in this three-month program revealed four themes: (1) friendship, (2) self-determination, (3) goal setting, and (4) barriers. The results of the qualitative inquiry indicate that a virtual practicum program can have a positive effect on both the participants and the professional preparation students. Virtual programs should also be aware of barriers to implementing an effective program to benefit all parties. Youth with visual impairments are often delayed in comparison to their same-age peers in physical activity levels and development of their motor skills and balance ,2,3,4,5.In addition to the physical activity and motor development deficits found in youth with visual impairments, their physical education teachers are often unsure what to teach them and how to include them in class safely. Teachers have expressed that students who have a visual impairment are one of the most difficult populations to teach in physical education . In addiSeveral studies have analyzed the effect of practicum programs on self-confidence in professional preparation students to teach youth with disabilities in physical education. Jeong and colleagues  comparedQualitative research of practicum experiences has revealed positive outcomes. Hodge et al.  conductePracticum experiences have also been shown to benefit youth with visual impairments. Lieberman and colleagues  studied Despite the benefits for both pre-service teachers and youth with visual impairments, Layne and Balsingame  determinThe Institutional Review Board of the lead researchers’ institution approved this study. A call for participants ages 6–19 years with visual impairments went out on listservs and social media groups. Thirty youth with visual impairments volunteered to engage in a three-month virtual practicum. The 1:1 coaches included pre-service teachers in the field of physical education teacher education who were involved in one of two adapted physical education classes. An email went out to families who signed up for the program to participate in the qualitative portion of the study. In the end, 10 youth with visual impairments (athletes) from New York, Massachusetts, Georgia, and California signed up for the study. See The overall goal of the program was for the athletes to improve their motor skills and physical activity and for the coaches (pre-service teachers) to learn how to teach youth with visual impairments. The virtual practicum took place over three months. First, athletes were paired with undergraduate pre-service teachers (coaches) in a physical education teacher education program in the northeast of the United States and provided with each other’s contact information. The practicum required that the pairs meet a minimum of once a week for 60 minutes and work on fitness as part of the program; however, they could choose the virtual platform, when to meet, how often, and what physical activities to work on. The program started with an opening ceremony attended by the athletes, their parents, and their 1:1 coach and included an explanation of the virtual practicum. At this time, each athlete also completed a short fitness assessment consisting of four components: duration of a wall sit, number of push-ups, number of sit-ups, and duration of a plank. Six weeks into the program, there was a “check-in” where the athletes could share what they had been doing and what they were proud of. Additionally, the four fitness components were re-assessed to determine improvement. This “check-in” included elite athletes sharing their stories of their journey into elite sports. The last week of the program consisted of a closing ceremony where every athlete completed their final fitness assessment and shared their accomplishments. There was also an elite athlete sharing his accomplishments and providing words of wisdom for success in the future. This qualitative phenomenological study included semi-structured interviews and focus groups related to the three-month virtual practicum. Phenomenological research studies examine the essence of the lived experience of an individual or a group of individuals related to a specific phenomenon . The pheSemi-structured interviews and focus group scripts were developed by the lead researchers to ensure the totality of the lived experience of the participants and their coaches was captured in the data. The lead researchers began with the end in mind by developing questions that would provide the answers to critical information needed to understand the effectiveness of the program. The overall purpose of the questions was to understand the lived experience of the virtual program by the athletes and the coaches. The scripts were sent to six experts in the field to ensure face and content validity. There was one athlete who is blind who is also a physical education teacher, three professors in motor development and adapted physical education who have expertise in working with youth with visual impairments, one parent, and one teacher of youth with visual impairments. Some of the guiding questions for the focus groups were as follows: (1) How did you measure improvement? (2) What was motivating to your child? (3) What about the personal best program was motivating to you? (4) Did you find this program enjoyable? Why or why not? (5) Were there any barriers to executing your lessons? (6) What did you find helpful to completing your lessons? (7) How did you feel about the online format of the program? (8) What could make this program better? The guiding questions for the athlete interviews were as follows: (1) How would you summarize your experience in the virtual program? (2) Do you feel that you made any new friends or that you became closer to any of the other athletes during the course of the program? (3) What barriers to being involved in physical activity did you experience during this program? (4) What helped you engage in sports and physical activity during this program? (5) As a result of your involvement in this program, what changes did you experience in yourself? (6) How do you feel this program helped you self-advocate for what you need in sports and recreation? (7) As a result of your involvement in this program, what improvements did you notice in your locomotor and ball skills? (8) As a result of being involved in this program, how do you feel you can be more involved in sports and recreation in your school and/or community? (9) How could this program have been better for you?The researchers conducted online interviews using the scripts with the athletes at the end of the three-month program to capture their experience during the virtual practicum. Each interview involved asking a series of structured questions and subsequently probing more deeply with open-form questions to acquire additional information . At the Three of the qualitative researchers analyzed the interview and focus group transcriptions. The investigators first independently coded the transcripts for major themes, subthemes, and supporting quotes to fully understand the entirety of the transcript data . The resThe concept of trustworthiness refers to the level of confidence in the data, interpretation, and methods employed to ensure the quality of truth of a study . TrustwoIn this study, 30 youth with visual impairments engaged in a 3-month virtual practicum with 1:1 coaches who were pre-service teachers in the field of physical education teacher education. Each youth and their coach met at least once a week and chose their specific activities, virtual platform, meeting time(s), and the duration of each activity. The results highlight the effects of the program on both the athletes’ learning of skills and improved physical activity and the coaches’ understanding of pedagogical instructional approaches. Please note that these themes and sub-themes in the findings reflect the experiences of both the athletes and the coaches as they worked together and acquired these experiences together. Clarification was made in each quote if the response was from an athlete or a coach. The findings in this three-month program revealed three themes: (1) friendship, (2) self-determination, and (3) barriers.Many of the athletes and coaches in the virtual practicum emphasized the value of forming friendships with one another over the course of the program.Coach Heather shared:We had something in common. We both play the same sport, which is wrestling, and also at the time, we’re both huge Marvel fans and at the time, we were watching two of the shows. It was just kind of like fun to like talk to him, and there’s just like there’s so much in common.Coach Jamal stated that: …it was like it was kind of more than like a camp, it felt like I was just like talking to one of my friends, and we just kind of formed a bond, and I really appreciate it too. I’ll definitely keep talking to him for a long time.Coach Jamal also noted: “Yeah in the end I loved it. I mean I made a friend out of it. So if anything else that was good.”Staying connected every week was huge for so many of the participants. Coach Rachel shared, “She loves having conversations, she’s always like so excited to see us and just like having like that kind of a bond with her was like, made it worth it.” Brian, an athlete in the program, expressed this sentiment in his statement, “…with my coach, I definitely feel like we had a pretty good relationship.” Even the practicum instructor and the physical education teacher of several athletes observed the friendships form and noted the importance of the connection. The practicum instructor stated:… just seeing the relationships that they built it was, it made me so happy to know that, like the kids aren’t as isolated as they were during COVID-19 because now they have this coach that cares about them and is meeting with them at least once a week.She also shared: The concept of friendship and socialization was huge, and a lot of them considered their college coach their friend. And some of them were like, they’re my best friend, you know, because they’re meeting with them a couple times a week.The physical education teacher had similar observations. She stated:When I think of a few students in particular, I think that who they were paired with, they were really connected to them. I know a lot of my students looked up to who they were with and were excited to like hear from them and everything. She also noted, “One student he um, his coach invited him to watch her play lacrosse on zoom or something. Like her game was aired and I thought that was really cool.” It appeared that during this time of isolation, all of the participants enjoyed getting to know someone new. Another theme that stood out with most of the athletes was the notion of self-determination. Within this theme, three subthemes were evident: autonomy, competence, and self-advocacy.Autonomy: “Each week we’d take her feedback and switch up our own plans a little bit.”Many of the coaches in the program wanted to provide their athletes with a sense of autonomy by allowing them to be involved in the planning of the workout sessions. The coaches provided the athletes with opportunities to make choices about the exercises they did, the times they met, how they met, and the music they listened to. Coach Jamal expressed:Typically, with Adam I would generate the activities that we were going to do. I like to give him choices too. I want him to have an opinion because if I’m doing something that he doesn’t enjoy as much, I’ll kind of veer away from that and try to go into other options for him. Along the same lines, Coach Heather stated: …we kind of would give her the choice because it was, we wanted to make it fun, it was a Thursday and she was almost done with the week, so she was just, it was a lot for her after school.Coach Heather also shared:I got his feedback on a couple but he said that he thought sit-ups did more than crunches for him so we would change something like that. Or he’d tell me, I really enjoy doing push-ups, so we added a little more push-ups. This idea that the coach started the line of ideas, and the athlete chose their preferred activities was a common finding. Coach Rachel said: …we’re like what activities do you want to do for this song, and she’s like, oh let’s do bicycle kicks and squats like she’s like, super involved with her own planning now, which is really cool. The concept was confirmed even more with Coach Jordan, who shared: With Tim, I generated the activities, but as he got stronger, he started adding to the activities. So, for example, if we were doing a jump squat, he would add a jump squat with a spin, a full spin. And he kind of did that pretty much to all of the exercises. Once he became stronger. But in the beginning, I generated it, and he kind of took over. Like even now, he’s taken over, he’s doing it by himself, really. And I have to keep up with him.Competence: “I can go longer, I can push myself harder”During this program, the coaches developed lessons and exercise plans that focused on fitness. Coach Heather expressed, “… we did a lot of just like exercise plans. We created about three or four together that work on just conditioning and different kinds of muscular strength and endurance workouts.” Coach Jordan stated, “We did a lot of muscular strength exercises and flexibility and core strength. A lot of crossbody type of strength for his balance as well. That was the main focus.” Nora reiterated this with her statement, “Just like exercises that you don’t need to have equipment for like lunges, wall sits, sit ups, high knees, jumping jacks, burpees, push ups, planks, squats, and things like that.”Many of the athletes felt as though they achieved better fitness over the course of the 12 weeks. Brian enthusiastically said, “I noticed that with some of the exercises that I did, I would get, I would like say like get stronger in my arms or legs.” Coach Rachel also supported this notion:I mean that like first field day that we had with everybody, she didn’t really know how to do a push up or like sit ups or anything like that. And now, I mean now she can go like a half hour, moving without really taking much of a break…Coach Gary shared a similar experience:I could tell that they’re doing more reps and holding planks longer, doing mountain climbers longer, running in place longer. My kid specifically was doing more push-ups, doing more burpees at a time. So, their cardiovascular endurance was increasing, and their muscular strength was increasing. Lastly, Adam expressed, “My endurance, my athleticism has changed. I can go longer, I can push myself harder, I can do more intense workouts than I could on the first day.”Goal setting was a key component for increasing fitness competence throughout the practicum. This was part of the philosophy of the program and a mantra that the participants followed. Brian clearly shared this when he said, “I thought it was pretty cool it was something different, because you could set your own goals for different physical activities that you would want to do….it was all about meeting goals.” Another participant, Adam, highlights the importance of goal setting for tracking progress:I’m almost there to reaching my goal that I had for this program. My goal for this program was to have both of my skate blades, touching the pipes on the net. Six feet across 180 degrees out. And I’m almost there. I’m like so close, probably by next Saturday. I’m going to have it.This was also expressed by another coach:I mean I think we met our goal with Latisha being able to run and stuff, like she knows how to move her arms, she knows to move her legs and arms at the same time. And, Emma and I both said it looked good. She came a long ways from where she was.Coach Jordan highlighted the motivational side of goal setting for both coach and athlete. He stated:For Tim, it was just seeing him light up every time I would log on to zoom and he was ready, he had a smile on his face. Every time we started, he would complete the task he was ready to go right to the next exercise. And that just motivated me to, you know, cuz he wanted to do it. I wanted to make sure that I gave him, you know, the very best that I could to help him to reach his goals.The physical education teacher also agreed with this concept, saying, “I think overall their goals were pretty much met, and they kept consistent, and they were motivated because they kind of had set goals for themselves before we started.”Self-advocacy: “It helped me self-advocate”The athletes described how the program gave them the tools and language to self-advocate for themselves during and outside of the program. For example, Adam stated:It helped me self-advocate, because some of the exercises that I didn’t, that were unfamiliar to me I would ask the coaches to explain it, which is a big part of self-advocacy asking someone to verbally explain what they’re doing, because I’m a B1 I cannot see what the motions they’re doing on my iPhone.Latisha’s mother offered a similar example. She shared: … in the middle, she [Latisha] just like started to begin directing the session where she would try to convince us like no I’m gonna, I’m gonna do sit ups instead of jumping jacks right now. And then is like, well, you want to make me do sit ups, give me an object on my feet so I can come up and get it and lay back again.The practicum instructor also supported this notion, stating, “So, he was very clear on what he wanted. How often he could meet, what his goals were. And the more that the child knew what they wanted and could communicate the better the situation was.” The physical education teacher reiterated the sentiment of self-advocacy. She shared: I had a high schooler who participated, and she’s like how do I let them know like what’s going on with me and I, so we kinda talked about how you can share with other people, what you can say, like its ok to say I don’t know what you’re talking about, can you explain that in a different way.Even the youngest athlete, Latisha, at six years of age, began advocating for herself. Outside of the program, her mother observed her asking to hold her sister’s and friends’ hands to run on the playground rather than being left behind.Although the athletes and coaches were excited to be part of this program, there were some clear barriers, which included technology, space and equipment, and age.Technology: “We were very limited through a screen”Many of the pairs experienced internet issues when trying to connect through Zoom or Facetime for their scheduled lessons. Jose shared, “It was virtual so it was tricky. Um, sometimes, a few times, either I was waiting in the room, it said ‘please wait’ to let you resume, and then it never let me in, so, a little technical difficulties.” The physical education teacher shared, “…getting online independently is a bit of a challenge for some students, so if they didn’t have a parent home or weren’t with someone who could help them, they had to miss the session.”Nora said “… my siblings are also on online school, so there was there were some Internet issues where I would drop out or I couldn’t hear her or she couldn’t hear me, but that’s about it.” More challenging for the coaches and athletes was the challenge of accessible cues and feedback. Many coaches struggled to see their athletes during the lesson because the athlete couldn’t visually see where the camera was facing, and they were often out of visual range. Additionally, many athletes couldn’t see the demonstrations of their coaches on the screen and some coaches struggled to provide descriptive enough cues to accompany the exercises. Brian expressed, “Oh, I noticed that I couldn’t, I didn’t know exactly what they were showing me. It would have been kind of hard on Zoom or Facetime or something to show that.” The practicum instructor heard this time and again from her students, stating, “…if a child was blind, they didn’t know if their camera angle was on them or not, so the coach couldn’t always give them feedback.” Coach Rachel expressed:…being online and working on a screen, she couldn’t see my demonstration; she wasn’t able to... I wasn’t able to like model physically for her or move her or help adjust or anything; it was all verbal almost, and that doesn’t work all the time… And she would get up to the screen and I would try to do it, but I’d be too far back and if I moved up, she couldn’t see my whole body so it was like just a really tough situation with modeling.Coach Jordan found ways to overcome the issue: “I found it challenging, but I was able to adjust as time went on and learn how to give the proper cues and things like that.”Space and Equipment: “I adapted to the area and just use what he had”Several coaches noted that space and equipment were limited for their athletes. Coach Rachel expressed, “He could lay, like his entire body could go on the floor like he could lay down to do a push-up and everything. That’s really the only space he had to do exercises in.” The practicum instructor saw this too:I think some of the kids didn’t have the proper equipment, like if they wanted to do baseball or they wanted to do basketball with the bell ball, they might not have had that equipment, some of the kids didn’t have the space to go running outside, or to do their fitness outside.Interestingly, the coaches were the only ones who found the limited space and equipment of the athletes a barrier. This shows how well the coaches were able to adapt their lesson plans to utilize the available space and equipment, so the athletes didn’t feel limited in the activities. Coach Rachel shared, “… all the exercises we did were just body weight because she had really limited space to work with. She only had a tiny bedroom.” Coach Jamal had a similar experience:…so we did a lot of stationary workouts like different things like push-ups or stretches or we just kind of, I adapted to the area and just use what he had, and the ceiling isn’t very high either, so we couldn’t do things like jump squats or anything that involved him jumping.Age: “The whole age thing has a factor”The coaches in the program identified the age of the athletes as a barrier. Many coaches who worked with a younger athlete experienced more challenges than those who worked with older athletes. The younger athletes struggled to stay on task without a support person in the home. When the athletes were younger, all communication had to go through the parents. If the parent wasn’t home when immediate communication was needed, the athlete often missed out on the lesson. This was clear with Coach Holly:I think the whole age thing has a factor, too because Latisha was only six, yeah. So, it was very hard to have her focus on just me when she has like three other siblings too that are running around the house at the same exact time.Coach Heather had a similar experience:…it was just a struggle to get her to do anything. So, I enjoyed it a lot because we would start off really well and then the end of the lesson would go downhill, and her mom would just leave her in the room and kind of just leave us alone with her. And we would try to talk to her, and she was just in the zone where she didn’t want to pay attention to us. So, I think it’s really hard. I think maybe working with older kids would have been a bit easier because we had a six year-old so she kind of, I think she struggled with knowing what we had planned for her, and if her mom wasn’t there I don’t know if we would have been able to do as much.Along the same lines, Coach Marcus expressed:I think age was clearly a barrier too because Jose’s 10 and Adam is 17, so everything with Jose I would have to go through his mom and I couldn’t just text him hey like could you actually meet at 3:15 instead of 3:30 today, or does this time still work? Everything it was just... there was one time where I had logged on, and he said he had logged on and then no, there was nothing. I waited 30 minutes, and then I was like okay I guess we’re not meeting today, maybe a conflict came up but like he couldn’t communicate that with me, and then the mom emailed me as I’m going to work and was like, oh Jose logged on and you weren’t there. I was like what? I was like, oh okay maybe the Zoom link’s broken because we both were there, so it was just like a couple issues that would happen, because he’s 10, he doesn’t have a phone, you can’t just text him. This study illuminated a better understanding of the experiences of youth with visual impairments in virtual practicum programs through listening to their voices. The qualitative nature of the experiences of the athletes and the professional preparation students in this study is an expansion of previous research in this area ,22,23. TOne of the benefits of this program was the long duration of three months. Most practicum programs are 6 to 10 weeks long. This duration is closer to the length of Sato and Haegele  and StanTo the authors’ knowledge, this is the first study to examine the experiences of athletes with visual impairments and their coaches regarding a virtual physical activity practicum. Although this study provides some promising results, further research should be conducted to examine the effectiveness of virtual physical activity programming in youth with visual impairments upon self-advocacy, socialization, and motor competence. Second, it is important to note that a friendship theme developed through this experience, considering there were no in-person sessions. Third, it is important to recognize that a theme of self-determination emerged from this study with three subthemes: autonomy, competence, and self-advocacy. Self-determination and socialization are both components of the Expanded Core Curriculum (ECC) which were also found to improve across a one-week in-person sports camp for youth who are visually impaired . FinallyThe current study was conducted during the height of the COVID-19 pandemic. The professional preparation students needed practicum experience, and the youth with visual impairments needed physical activity opportunities. This was a convenience sample with limitations in space, technology, internet availability, and time constraints. The time that the youth were available did not always match the time the professional preparation students were available. There was also, at times, a lack of adequate equipment in the homes of the youth. Lastly, children who were too young to have a cell phone at times found it challenging to connect with their coach  when the parents were unavailable. The strengths of this study were the study duration of three months, the often-enthusiastic engagement of the youth with visual impairments, and the 1:1 nature of the practicum.This study illuminated the benefits of a virtual practicum program for children with disabilities. The benefits of the program were tremendous and were related to physical activity improvements, self-determination, socialization, and friendships. The fact that the program was inexpensive was a plus, as this can be a barrier to some programs related to transportation and equipment. In addition, the fact that the youth and the 1:1 coach chose their times to meet was individualized gave them autonomy and self-determination. This study can be replicated with youth with any disability. It can be experienced with the children participating alone or with their parents and siblings. It can also be conducted with more than one professional preparation student, as in a few instances, several of our students Zoomed in with their athlete. Lastly, it can be conducted with a specific curriculum to follow specific skills and activities, or as we did with the program, following the preferences of the athlete and their coach.


RNA binding proteins (RBPs) have a broad biological and physiological function and are critical in regulating pre-mRNA posttranscriptional processing, intracellular migration, and mRNA stability. QKI, also known as Quaking, is a member of the signal transduction and activation of RNA (STAR) family, which also belongs to the heterogeneous nuclear ribonucleoprotein K- (hnRNP K-) homology domain protein family. There are three major alternatively spliced isoforms, QKI-5, QKI-6, and QKI-7, differing in carboxy-terminal domains. They share a common RNA binding property, but each isoform can regulate pre-mRNA splicing, transportation or stability differently in a unique cell type-specific manner. Previously, QKI has been known for its important role in contributing to neurological disorders. A series of recent work has further demonstrated that QKI has important roles in much broader biological systems, such as cardiovascular development, monocyte to macrophage differentiation, bone metabolism, and cancer progression. In this mini-review, we will focus on discussing the emerging roles of QKI in regulating cardiac and vascular development and function and its potential link to cardiovascular pathophysiology. Transcriptional and posttranscriptional modifications are critical in regulating gene expression . Posttracis-regulatory nucleotide sequences and trans-acting factors  family, which belongs to the hnRNP K-homology domain protein family . QKI is v mouse line is a well-known spontaneous mutant mouse line, in which a 1 Mb promoter/enhancer region is deleted at the upstream of the Qki transcription start site and results in myelination defect in the central nervous system  are capable of differentiating into monolayer cardiomyocyte sheets but have dramatically weaker and asynchronous spontaneous-beating activity. Transcriptomic analysis at a single-cell resolution confirms that hESC-QKIdel largely maintains pluripotency, self-renewal activity, and early cardioprogenitor differentiation ability but has a significant defect in becoming functional cardiomyocytes. Genes involved in contractile function, such as ACTN2 (α-actinin), MYL2 (myosin light chain 2), MYH7 (β-myosin heavy chain), ANKRD1 (ankyrin repeat domain 1), TNNI3 (troponin I3), ACTA1 , and TAGLN (transgelin), are downregulated significantly in cardiomyocytes derived from hESCs-QKIdel, suggesting that the altered contractile function in QKI-deficient cardiomyocyte sheet is mainly caused by the altered regulation of sarcomere genes. Interestingly, a replicate multivariate analysis of transcript splicing (rMATS) revealed altered alternative splicing in Z-line proteins, such as ACTN2, NEBL, ABLIM1, PDLIM5, and the proteins connecting the Z-line to the M-line in the sarcomere, such as TITIN. The Z-line provides an essential anchor for sarcomerogenesis and contractile function (ACTN2 splicing creates a premature STOP codon that leads to the activation of non-sense-mediated decay (NMD) and consequently to the striking downregulation of ACTN2 expression -induced cell death in cardiomyocytes by antagonizing the elevation of the proapoptotic transcription factor FoxO1 in response to cardiac injury . FoxO1 aQKI expression can be strongly induced in vascular smooth muscle cells (VSMCs) in response to vascular injury and is shown to be involved in VSMC dedifferentiation via its regulation of alternative splicing of Myocd, a well-known master transcription factor in smooth muscle differentiation . PerturbA recent study demonstrated that QKI-6 regulates HDAC7 splicing and promotes VSMC differentiation from induced pluripotent stem cells (iPSCs). Remarkably, QKI-6-overexpressing smooth muscle cells show a greater contractile ability, and when cocultured with QKI-5-overexpressing endothelial cells, QKI-6-overexpressing smooth muscle cells exhibit a greater angiogenic potential , suggestQKI is highly expressed in both macro- and microvascular endothelial cells . Severalin vitro, which likely occurs via its activity in binding to the 3′UTR of VE-cadherin and β-catenin mRNA and the regulation of VE-cadherin and β-catenin mRNA translation (Interestingly, QKI-7 can be significant upregulated in mouse iPSC-derived endothelial cell when exposed to hyperglycemia mimicking diabetic pathophysiological condition . Importanslation . CollectThis mini review summarizes a series of recent exciting data on the physiological role of QKI in regulating numerous important features of cardiovascular development and function. As shown in XC and JY drafted the manuscript. DC and DX revised the manuscript. ZZ, YL, and WS finalized the manuscript. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Applying innovative online approaches to interventions for preventing depression is necessary. Since depressive emotions are typically shared within the family, the development of interventions involving family members is critical. This study thus aimed to examine the feasibility, acceptability, and preliminary outcomes of a new online self-help intervention, MindGuide, among Korean college students’ families. We developed MindGuide, which integrates cognitive behavioral therapy with mindfulness and an emotional regulation approach. A one-group pretest–posttest design was used to measure the changes in the Center for Epidemiological Studies Depression Scale, the Attitude Toward Suicide scale, and the Satisfaction With Life Scale before and after the intervention. Of the 34 families that began the program, completion rates were 88.2%, 85.3%, and 91.2% for fathers, mothers, and children, respectively. The findings indicated that the MindGuide program is feasible and acceptable for families of Korean college students. The results support the potential effect of MindGuide on reducing depression, improving positive attitudes toward suicide prevention, and enhancing family relationships in participants at risk of depression. However, future research is needed to thoroughly explore and evaluate the efficacy of the MindGuide program. Depression is one of the most common mental illnesses that increases the mental health-related disease burden globally and the risk of suicide ,2. In KoMoreover, an increasing trend of depression has been observed among people in their 20s and middle adults in Korea . SuicideConsidering the busy lives of Korean college students’ and middle-aged parents, it is necessary to apply innovative online approaches as interventions to prevent depression. Online interventions can provide opportunities for easy access to mental healthcare in an earlier stage of depression without the financial, geographic, and time limits that traditional offline interventions have ,8,9. In Furthermore, previous studies have investigated the meaning of culture for expressing depressive symptoms and found that culture shapes the symptoms and expressions of depression . KoreansSince people in collectivist cultures such as China, Japan, and Korea emphasize social relationships, including family, friends, and neighbors, depression is associated with social relationships, including loneliness, social support, and frequency of social contact ,24,25. IHowever, most family-oriented interventions included patient–caregiver dyads, not family triads . Therefore, the purpose of this study was to explore the feasibility of recruiting and retaining family triads, as well as the acceptability of the new online IEB intervention, MindGuide, we developed, with Korean college students’ families. In addition, we evaluated the preliminary outcomes  of the intervention in two subgroups formed by the Center for Epidemiological Studies Depression Scale (CES-D) cutoff score.This study used a single-group pretest–posttest design and a mixed method. The Ewha Womans University IRB (IRB#: 126-15) approved this study, and informed consent was obtained from the participants prior to data collection.As MindGuide was eventually developed to prevent depression and suicide among Korean adults in the context of family, we recruited Korean college students’ families consisting of fathers, mothers, and children using online advertisements on the MindGuide website and several social media platforms. We have provided the study information and consent form on the MindGuide homepage. If people left their contact information, including names, email addresses, and telephone numbers, the research assistant (RA) contacted them by telephone to screen for eligibility. The inclusion criteria were as follows: (a) having a 19–29-year-old college student; (b) all family members  agreeing to participate; and (c) being able to use email and the Internet with a mobile device . We excluded families who (a) had divorced or separated parents; and (b) had a family member who was diagnosed with depression or other mental diseases and was currently receiving drug treatment or other psychotherapy. This is because taking antidepressants or other psychotherapeutic drugs may influence the effectiveness of the intervention. The RA contacted each family member separately and explained the study to them.If all family members met all eligibility criteria, they received a welcome email with a MindGuide ID, which included a family ID number and individual number. During the first visit to the online MindGuide program, each family member created an account using the provided ID number and completed the registration process, including online informed consent and the baseline survey. They were then able to log on to the MindGuide program at any time until they completed the program modules. We offered $90 incentives to each family member to complete the program.http://mindguide.kr, accessed on 12 February 2022) is a new online self-help intervention that focuses on promoting mental health and preventing depression in college students’ families through the integration of CBT [MindGuide  and revised based on their feedback. Experts were requested to rate the content validity in each module on a four-point scale ranging from 1 to 4, with a higher score indicating extremely helpful content. After the experts individually scored each module, the content validity index of all modules ranged from 0.80 to 1.00, with an average of 0.98, indicating high validity. These models were adopted as the interventions.The program was developed on a mobile responsive website, so that it can be accessed using a computer, tablet, or mobile phone at any time and place. Participants completed 24 sessions and activities sequentially twice a week for three months, and all data were collected online. The participants received an incentive when their participation was terminated.Data were collected between March 2017 and November 2017. Feasibility, acceptability, and preliminary outcomes of the intervention were assessed both qualitatively and quantitatively. Feasibility refers to participant recruitment, retention, and completion rates . AcceptaTo evaluate the feasibility and acceptability of MindGuide, the participants were asked to respond to questionnaires and semi-structured interviews after completing the program. Interviews lasted 30–60 min and were audio-recorded and transcribed for the data to be analyzed. Participants were asked questions such as, “Do you think MindGuide would be effective to prevent depression?” “What content and activities are you satisfied with the program?” and “How acceptable do you feel it is to participate in the program?”We evaluated the rate of program completion and the participants’ perceptions of the program’s impact. Program satisfaction was measured using a five-point scale from 1 to 5; a higher score indicated greater satisfaction. Depression, attitude toward suicide prevention, and life satisfaction were measured at baseline and after the intervention to evaluate the effectiveness of the intervention.Depression was measured using the 20-item CES-D . Each itAttitude toward suicide prevention was measured using the Attitudes Towards Suicide (ATTS) scale . We founSatisfaction with life was measured using the Satisfaction With Life Scale (SWLS) . The SWLThe participants’ characteristics were analyzed using descriptive statistics. Differences between completers and non-completers were assessed using the chi-square and Mann–Whitney tests for small sample sizes. In addition, differences in study variables between family members were evaluated using analysis of variances (ANOVA). All analyses were performed using SPSS version 27 .Feasibility was examined by the number of people logged into the program homepage and the completion rate of each module and the entire MindGuide program. To explore acceptability and perceived outcomes, the responses to the questionnaires and semi-structured interviews were analyzed using content analysis . The ansd for a small sample size. Cohen’s d was calculated by subtracting the post-mean from the baseline mean and dividing this by the pooled standard deviation of the two means. Effect sizes of ≤0.20, ≥0.50, and ≥0.80 were considered to be small, medium, and large, respectively [Changes in the preliminary outcome variables between baseline and post-intervention were evaluated using the within-group effect size and Cohen’s ectively . Outcomeectively .The final sample for all analyses comprised 90 individuals: 29 mothers (32.2%), 30 fathers (33.3%), and 31 children (34.5%). The baseline participant characteristics are presented in F = 6.97, p = 0.001) among the groups. In addition, the findings of the post-hoc tests indicated that fathers had significantly lower ATTS scores than mothers and children.The mean income satisfaction was 3.03 ± 0.67 for fathers, 2.94 ± 0.86 for mothers, and 3.32 ± 0.88 for children. There were no significant differences regarding satisfaction income, CES-D scores, and SWLS scores, but there was a statistically significant difference in ATTS scores (The flow of participants through the program is shown in p = 0.51) and depression .The completion rates were 88.2%, 85.3%, and 91.2% for fathers, mothers, and children, respectively . Twelve After completing the MindGuide program, the majority (81.1%) of participants reported satisfaction with it . In the The majority of participants (82.2%) reported satisfaction with family case-based learning and activities . One mother stated, “It was helpful to me to have specific examples on how to be aware of my feelings and to write them down. I could apply what I learned through the program to my daily lives.” The other said, “It was great to take a photo to memorize the moment when my husband and I wrote down what happiness is and what we could do for that.”However, a few (5.6%) did not find some of the teaching resources to be acceptable. One participant mentioned that the materials presented in the text and illustration could be boring and that audio, or video clips, might have been more preferable. A few participants experienced technical errors when they participated in the program. Moreover, some participants suggested that receiving feedback from research teams through email or phone calls during the program might be helpful in keeping their interest and attention to complete the program.Most participants (92.2%) thought MindGuide helped them reduce their depressed mood by learning how to be aware of and express their feelings. In addition, they reported increased calmness and relaxation by practicing mindfulness. Some participants stated that the program made them more positive, so they were able to look at life more positively.Participants (48.9%) believed that the program helped them create a more positive family relationship. They realized the importance of family and practiced expressing love for their families. Participants stated that learning communication techniques allowed them to express their feelings and thoughts consciously to family members, thus helping to enhance family relationships. A mother reported, “I used to be angry at the son without telling him why I was angry. However, through the program, I learned a lot about my communication skills. Now I am able to talk about my depressive mood to my family.”d) are shown in d = 0.32), mother (d = 0.69), and child (d = 0.52). However, the participants in the normal group perceived no change (d = 0.16~0.10).The means and standard deviations of the study variables and within-group effect sizes (Cohen’s d = 0.25~0.80). While the father in the risk group (d = 0.29) and the mother in the normal group (d = 0.25) reported a slight improvement in life satisfaction, the father in the normal group, the mother in the risk group, and the child experienced no change.All participant reports on the ATTS indicated that they experienced improved adaptive attitudes toward suicide prevention with medium to large within-group effect sizes  were excluded during screening for eligibility, the completion rate of the entire program (88%) was high. Especially, children had higher completion rates than parents. This is not congruent with the results of a systematic review study  which rehttp://mindguide.kr/.(accessed on 12 February 2022) They also participated in the program in their own time and at their own pace. This is similar to findings from a systematic review and meta-analysis, which reported that online mental health interventions are easily accessible and widely disseminated at a low cost [Our findings suggest that the MindGuide program is acceptable to Korean college students’ families. All participants generally expressed satisfaction with the MindGuide program. In particular, they were satisfied with the learning family case study, which helped them to understand another family member and to apply what they learned in their daily lives. Moreover, training family members via the internet offered many potential benefits. Participants reported that they could easily access the program at any time and place through the mobile responsive website: low cost .However, some elements of MindGuide, such as technical errors and lack of coaching support, were not highly acceptable. These results reflect previous findings that lack of motivation and technical problems were reasons for drop out . To makeAfter participating in the MindGuide program, the participants thought that the program helped them to reduce their depressed mood and create more positive family relationships by realizing the value of family and learning communication techniques. Most family-based preventive interventions primarily target the prevention of mental problems  by strengthening family relationships and resilience ,47. SimiThe current study highlights the potential benefits of the MindGuide program on depression, especially in the risk group (CES-D ≥ 16). Participants’ depressive symptoms in the risk group were reduced after completing the MindGuide program, and the effect size was medium to large. Conversely, we found no significant change in depression in the control group (CESD < 16). The results suggest that participants at risk for clinical depression might benefit more from the MindGuide program for reducing depression than those who are not at risk.Moreover, all participants experienced improved positive attitudes toward suicide prevention, with medium to large effect sizes. This finding is consistent with previous research showing that family suicide care educational intervention is effective in increasing suicidal caring ability and positive attitudes toward their suicidal family members . One posDue to several limitations related to the single-group pretest–posttest design and the small sample size, the findings of this study should be interpreted with caution. Future research with a control group and a larger sample is needed to obtain further insight into the effectiveness of the MindGuide program on mental health. In addition, despite collecting family triad data, we could not analyze the data at the family level because of the small sample size. Additional studies with a large sample size should thus consider data analysis at the family level. Finally, convenience sampling, which was used to recruit Korean college students’ family triads, also limits the generalizability of the results to older adults, some of whom may not be well educated. This suggests a need for future randomized controlled trials with diverse populations. Despite these limitations, one of the strengths of this study is that we used a mixed method methodology to obtain more in-depth information about whether MindGuide is feasible, acceptable, and effective.The study demonstrates that MindGuide, a new online self-help IEB intervention, is feasible, acceptable, and effective in reducing depression and improving positive attitudes toward suicide prevention for Korean college students’ families. Although the effect size of depression was medium to large only in the risk group, most participants experienced that the MindGuide program helped to decrease depression and strengthen family relationships. This suggests that MindGuide could be used as a vehicle to prevent depression and suicide.


Maintaining acute care physician competence is critically important. Current maintenance of certification (MOC) programs has started to incorporate simulation-based education (SBE). However, competency expectations have not been defined. This article describes the development of a mandatory annual SBE, competency-based simulation program for technical and resuscitation skills for pediatric emergency medicine (PEM) physicians.The competency-based medical education (CBME) program was introduced in 2016. Procedural skill requirements were based on a needs assessment derived from Royal College PEM training guidelines. Resuscitation scenarios were modified versions of pre-existing in-situ mock codes or critical incident cases. All full-time faculty were required to participate annually in both sessions. Delivery of educational content included a flipped classroom website, deliberate practice, and stop-pause debriefing. All stations required competency checklists and global rating scales.Between 2016 and 2018, 40 physicians and 48 registered nurses attended these courses. Overall course evaluations in 2018 were 4.92/5 and 4.93/5. Barriers to implementation include the need for many simulation education experts, time commitment, and clinical scheduling during course events.We have developed a mandatory simulation-based, technical, and resuscitation CBME program for PEM faculty. This simulation-based CBME program could be adapted to other acute care disciplines. Further research is required to determine if these skills are enhanced both in a simulated and real environment and if there is an impact on patient outcomes.The online version contains supplementary material available at 10.1186/s41077-021-00170-4. Maintaining physician competence is critically important in acute care settings in order to deliver high-quality, evidence-based care. Current maintenance of certification (MOC) programs require mostly passive learning strategies. Simulation-based education (SBE), often in the form of in situ mock codes, has been widely adopted for post-graduate training. Efforts to incorporate simulation into MOC for practicing physicians have recently been introduced in some disciplines; however, performance is not linked to competency expectations , 2. AnnuPhysician knowledge decay is a well-known phenomenon after post-graduate training. In fact, skill decay has been demonstrated in numerous cardiopulmonary resuscitation (CPR)-based courses –8. To maSome studies have shown that participant satisfaction is greater with simulation-based workshops and courses compared to traditional lecture-based courses –13. SimuCompetency-based medical education (CBME) has attracted the attention of educators and accreditation bodies –26 as itAlthough it is well known that simulation-based education addresses many educational and competence assessment needs for physicians, its utilization in a competency format for faculty members in pediatric emergency medicine (PEM) has not to our knowledge been previously studied. This paper describes the development and implementation of a mandatory simulation based CBME program for faculty in PEM.We developed a mandatory simulation competency-based procedural and resuscitation program in pediatric emergency medicine. In this report we describe the program, the curriculum from 2016 to 2018, and the applicability to other acute care settings aiming to adopt similar programs.This program was implemented in 2016 in the emergency department of a tertiary care pediatric hospital. At the time of implementation, there were 28–30 full-time staff MDs, 6–8 half-time or greater contract staff MDs, 16 PEM fellows, 6–7 advanced training fellows , and over 100 RNs. In 2018, the ED had 80,555 patient visits of which the Canadian Triage and Acuity Scores (CTAS) were CTAS 1 (1.1%), CTAS 2 (19.7%), CTAS 3 (45.3%), CTAS 4 (27.1%), and CTAS 5 (5.8%).Problem identification—skills gaps identified, frequency of individual in situ simulations insufficient, recurring morbidity casesNeeds assessment—Royal College Training ObjectivesGoals and objectives—competency in core technical and resuscitations skillsEducational strategies—asynchronous website modules, annual simulation-based training, competency testingImplementation—leadership support, simulation centre resources, PEM education and clinical expertise, schedulingEvaluation—course evaluations, faculty feedback (future study), effect on in situ simulation performance (future study), mastery testing (future study)The CBME program for PEM faculty was introduced in 2016 and initially included training and assessment of both procedural and resuscitation skills. Although not done a priori, our curriculum development included the following stages of Kern's 6-step approach to curricular development .ProblemOur division undertook a physician skill needs assessment based on existing Royal College of Physicians and Surgeons of Canada Objectives of Training in the Subspecialty of Pediatric Emergency Medicine and found that many physicians had not performed or infrequently performed many critical procedural skills. The top 4 ranked procedural skills were chosen for the first course from this needs assessment  cases which incorporated both Pediatric Advance Life Support (PALS) algorithms as well as cases which challenge participants’ team or crisis resource management (CRM) skills  was added to the procedural half-day component of the program. Nurses traditionally are expected to have a full day of education per year and so those assigned on the CBME day were active participants.PEM RNs completed a RN-focused procedural skills education half-day separately from the MD participants and then joined the half-day resuscitation team-based competency portion of the course. Due to RN staffing shortages, a maximum of 8 RNs were permitted to attend any given CBME session, resulting in 2 RNs per group. RNs not able to attend the CBME course were scheduled into the monthly interprofessional in situ mock trauma simulations. During non-CBME months, the nurses participated in the existing in situ mock traumas.Each resuscitation group consisted of 2–4 staff physicians and 2 RN participants which enhanced the interprofessional teamwork of the sessions. Participants were all expected to play a role which they would normally do in a real scenario. A debriefing session was held following each resuscitation scenario with the intention of clarifying medical issues arising in the case and discussing crisis resource management aspects including interprofessional teamwork.The range of MD participants per course was 10–19 and the number of instructors ranged from a minimum of 8 for a half-day and 16 for a full-day course, averaging approximately 1 instructor per POCUS/technical and 2 instructors per resuscitation stations. In total, 40 PEM physicians and 48 PEM nurses participated in the program from 2016 to 2018. The mean percentage of MDs participating per year was 85.4% and the mean percentage instructing per year was 42.8%.Station objectivesVideo instructionReading material: e.g., guidelines, journal articles, textbook chaptersChecklistAdditional resources or linksAn asynchronous flipped classroom approach was utilized. The RN-specific procedures eLearning was available on the SickKids ED intranet education page. A separate website with MD specific procedures and interprofessional (MD and RN) resuscitation case modules was created. Each learning module consisting of online videos and content-specific reading material was made available for the participants to review prior to the course. Website material was prepared by PEM and simulation experts as well as our interprofessional nurse education specialist (CG) based on RCPSC core knowledge requirements for PEM trained physicians as well as divisional clinical pathways, order sets, and procedural guidelines. Website material was password protected for participants. The competency checklists for each station were also available on the website (discussed below) so that participants may familiarize themselves with them beforehand. All MD and RN participants were expected to review the content material prior to taking the course. Station content included the following:Both Checklists and Global Rating Scale (GRS) specifically designed for each individual procedure or resuscitation station were used in order to assess competency throughout the full-day course. Checklists were designed separately for each station; some were modified from previously validated Objective Score of Technical Skills (OSAT) , while oFor resuscitation scenarios, checklists included Crisis Resource Management components in order to highlight the importance of team functioning during resuscitations. While checklists listed every step in performing a procedural skill or accurately running a resuscitation scenario, the most important of these steps were highlighted in bold. Participants were required to achieve all bolded checklist items in order to achieve overall competence on the GRS. Several studies have assessed validity of GRS in the emergency setting , 32 and Instructors with expertise within PEM education were identified and recruited to teach and evaluate each station. Instructors were directed on the components of the checklists and GRS, and asked to familiarize themselves with the website course material. Guidance on using the checklists and GRS to assess for competency was also given. A core group of instructors was identified as the course progressed, although instructors needed to rotate through competency days themselves as participants.For procedural competence testing, all participants utilized repeated deliberate practice, an education methodology of repeated skills and resuscitation training with feedback, and then completed a final competency testing –37. UnsuFor resuscitation competence testing, stop-pause debriefing  was utilAlthough individuals and teams infrequently were unsuccessful, performance data will be analyzed in a separate study.No formal rater training was utilized for the checklist and global rating scores. The majority of raters had used the checklists for other courses and our in situ mock code program so consistency of scoring was likely very high.Cost estimates were approximated , procedural was 4.95 (range 4.5–5.0), and resuscitation was 4.81 (range 4.63–5.0). Overall course scores started in 2018 and mean scores were 4.92 and 4.93 for each course.Overall comments for the course were very favorable. Technical skills comments included “great stations,” “friendly and positive learning environment,” “enjoyed viewing uncommon but potential complications to common procedures in the ED,” and “deliberate practice awesome”. Comments from resuscitation stations included “great for nursing to participate,” “hands on and interactive with constructive feedback in real time and conductive to my learning during scenario,” “makes people feel good even when feedback is constructive/negative”, “never felt judged or criticized”, and “love that it was a group scenario and focus was on team and communication.” Some barriers were also identified: “more facilitators to speed up assessments,” “long day, resuscitation sessions shorter,” “more nurses per group.”The authors report the development, implementation, and participant evaluations of an innovative multimodal continuing education course for faculty competency maintenance and assessment. Online learning material included key articles, clinical guidelines, videos, checklists, and online self-assessment tools. The hands-on procedures incorporated deliberate practice and resuscitations were debriefed using stop-pause methodology. A synthesis of systematic reviews showed that CME activities that were more interactive, used more methods, and involved multiple exposures were more likely to lead to improved physician performance and patient outcomes .Scheduling of both participants and instructors was and continues to be a challenge. Given the need to cover the clinical workload on CBME course days and individual’s academic responsibilities, developing a balanced schedule was difficult. On average 1–3 staff would “drop out” in the week leading up to the course. As these sessions are mandatory, most of these individuals would then request to participate in the following session leading to larger group sizes which ultimately impacted flow, timing, and instructor scheduling. The number of MD participants ranged from 9 to 17 per session. Additionally, the division continues to add new staff as the clinical and academic load has increased significantly each year.The number of instructors who have either simulation expertise or technical expertise could be a challenge for smaller programs. There are five staff with simulation fellowship training or equivalent as well as numerous faculty who participate in the simulation instruction of post-graduate trainees from junior resident through to PEM fellows, most of which have taken a simulation instructor workshop. Additionally, many staff have clinical expertise which was utilized for either technical or scenario case development and instruction. Despite this broad education expertise, approximately 12–15 MD staff educators and 4–5 RN educators are required per session, meaning that many of the simulation “experts” were required to teach multiple course in a row. As a result, these faculty have not been able to take the course as a participant on annual basis, as mandated by the program. For smaller programs with fewer simulation educators, it may be difficult to run a program of this size.Nursing participation was more challenging for the physicians for several reasons. Firstly, there are over 100 nurses in our division and so by sheer numbers it would very difficult to complete the CBME course in a given year. Additionally, the funding model for nurses only permits a limited number of paid education days per year. This allowed for just less than one-third of the RN group per year to participate. The remainder of the nurses continued to participate in the in situ program plus the pre-existing procedural training annually.Station and content development are important components of the program. Subsequent changes were iteratively made based on feedback from faculty evaluations and simulation/resuscitation expert panel. Ultimately, it will be important to define a set curriculum which can be rotated over subsequent years which represent both common and infrequent but high-risk critical skills. Potential solutions include repeating of a needs assessment as well as continuing to utilize quality reviews as a source for new case development.Although procedural and POCUS skills were easily evaluated individually, the resuscitation stations were evaluated based on team competence. Ideally, our competency evaluations should also include leader competency. Although most physicians lead at least one case, several courses with larger participant numbers hindered all MDs from participating in the lead position. Also, competence in one case is not necessarily generalizable to other station content. Individually testing all MDs across all cases would require repeating the cases 3 or 4 more times for each group which is not feasible in a half-day format. In the future, we hope to review the completion rates and incorporate strategies to move from a competency model to a true mastery model.Future research is required in order to evaluate the impact of this innovative program. Following Kirkpatrick’s hierarchy, evaluation of education programs happens at four levels: reactions, learning , behavior , results (patient outcomes) . As thisWe have developed an annual mandatory simulation-based technical, POCUS, and resuscitation CBME program for PEM faculty. Although challenges around scheduling exist, the course was extremely well received by participants with excellent participation rates. Ensuring lifelong competence in acute care skills is essential for PEM physicians and nurses. This program addresses gaps in the traditional models of MOC and skills decay associate with life support courses. Our simulation-based CBME program could be adapted and generalized to other acute care disciplines. Further research is required to determine if these skills are enhanced both in a simulated and real environment and if there is an impact on patient outcomes.Additional file 1. MD: Procedural Checklist. RN: Procedural Checklist.Additional file 2. Procedural Global Rating Scale (GRS).Additional file 3. Resuscitation Checklist.Additional file 4. Resuscitation Global Rating Scale (GRS).


Academic assessment of student competency is essential to measure learning within a gerontology program. In its self-evaluation, a program must assess its student learning outcomes. JoAnn Damron-Rodriguez et al.  proposed a systematic approach that has several levels. The key is to utilize a competency-based education model. Moreover, to satisfy workforce goals the gerontology program must adopt the AGHE competencies that reflect the knowledge, skills, and attitudes necessary to serve older adults at an acceptable level of care. The next step involves generating well-articulated quantitative or qualitative measures of student learning outcomes (SLOs) consistent with the program’s mission statement that include twelve competency domains. SLO measures include test grades, assignments, projects, portfolios, field experiences, essay questions, multiple choice items, and so on. The program’s enhancement loop requires the evaluation of SLOs, faculty discussion of them, and a continuous modification cycle "closing the loop" to reach the program’s goals.


Carlos Eduardo RochitteNeste editorial especial gostaríamos de prestar homenagens a um ícone da Cardiologia brasileira e responsável direto pelo desenvolvimento de uma das maiores instituições da Cardiologia mundial, o Instituto do Coração (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP). Nas palavras de 3 pessoas muito próximas a ele , vamos relembrar sua trajetória e traços de personalidade tão característicos deste líder inconteste de uma geração de cardiologistas. Como residente do InCor, tive a honra de conhecer e interagir com Professor Fúlvio que teve papel fundamental na minha carreira acadêmica. Primeiro, uma aparente barreira para entrar na pós-graduação: “para se inscrever na pós tem que ter estágio fora do país”, associada ao fato de que quase todas as bolsas de estudo no exterior exigiam como pré-requisito estar inscrito em um programa de pós, pareceu colocar uma barreira intransponível. Mas na verdade só me estimulou ainda mais a procurar alternativas para transpô-la. E de fato, ele abriu todas as portas para que eu realizasse o estágio na Universidade de Johns Hopkins. Depois disso, minha jornada já era história. Uma dívida eterna e um aprendizado para vida.Arquivos Brasileiros de Cardiologia (ABC Cardiol) e da comunidade científica queremos agradecer a todas as contribuições que Professor Fúlvio, direta e indiretamente, fez para nossa ciência em Cardiologia. Apenas para breve contextualização, o Professor Fúlvio publicou no ABC Cardiol, como autor ou coautor, 341 artigos, sendo o InCor, hoje, a instituição que mais publica no periódico.Em nome do Mas vamos às palavras de quem realmente o conheceu nas suas mais diversas nuances.Protásio L. da Luz1 formou-se na Faculdade de Medicina da USP em 1947. Estagiou no Instituto de Cardiologia Ignacio Chávez, México, como pós-graduando em Cardiologia. Ao voltar ao Brasil fez toda carreira acadêmica na USP, sempre ao lado do Professor Luiz V. Décourt, a quem substituiu como Professor Titular de Cardiologia. Assumiu a Direção do InCor em 1982 permanecendo como seu Diretor até 1997. Várias facetas de seu caráter merecem destaque. Foi personalidade marcante, forte, crítico de ideias e com amplo interesse em esportes e música clássica; tornou-se grande apreciador de vinhos. Sempre se manteve fiel a seus inúmeros amigos com quem apreciava conversar e trocar ideias sobre os mais diversos assuntos. Suas amizades cobriam amplo leque: políticos, empresários, advogados, magistrados e companheiros da universidade, sem fazer qualquer distinção de ideologias, raça ou gênero. Era afável e respeitoso no trato pessoal.Nascido em São Carlos, Fúlvio José Carlos Pileggi,Como médico, primou pelo conhecimento, bom senso e humanismo. De sólida formação clínica soube se cercar de especialistas nas novas áreas da Cardiologia, de modo que conseguiu aliar os aspectos humanos da profissão aos avanços das tecnologias de diagnóstico e tratamento. Íntegro, sempre colocou o interesse dos pacientes acima de tudo. Tratou igualmente personalidades importantes da vida nacional, incluindo presidentes da república, bem como homens simples do povo. Incansável estudioso mantinha-se constantemente atualizado. Graças a essas qualidades formou grande clínica particular, despertando irrestrita confiança em seus pacientes.Como professor universitário dignificou como poucos a carreira acadêmica, priorizando competência, integridade e dedicação. Foi um dos que mais combateram a politização nas universidades, defendendo que o preenchimento de cargos acadêmicos, reitores por exemplo, fosse realizado entre acadêmicos e não por pessoas alheias aos princípios fundamentais da universidade. Buscou excelência profissional em todos os ramos da medicina. Formou inúmeros discípulos a quem estimulou constantemente mesmo depois de deixarem a USP. Singularmente, ensinou mais pelo exemplo do que pela retórica.Como administrador fez do InCor-USP seu objetivo de vida. Ao criar a carreira de pesquisador, em tempo integral e com remuneração adequada, trouxe cientistas para a instituição tanto em áreas básicas como fisiologia, genética e biologia molecular, imunologia e biologia vascular, mas também para pesquisa clínica; isto mudou o patamar do InCor que passou de um hospital primariamente assistencial a um instituto de pesquisa e geração de conhecimentos. Era exigente como administrador, mas compreensivo, informal, íntegro e justo. Tinha clara visão do papel formador, desbravador, de uma instituição acadêmica. Assim, compreendeu e implementou o conceito sobre o qual o InCor se baseia em três pilares: ensino, assistência e pesquisa. No ensino, o InCor há muitos anos prepara especialistas do mais alto nível em cardiologia, pneumologia e cirurgia cardíaca e torácica, com seus cursos de mestrado, doutorado e especialização. De alto nível é seu curso de graduação, que dá a base que todo médico deve ter em cardiologia e pneumologia. Na assistência sempre procurou assegurar que o InCor prestasse assistência diagnóstica, terapêutica, psicológica, social, nutricional e outras, da melhor qualidade a todos os pacientes do SUS ou conveniados, independente de raça, gênero, ideologia ou religião. Através da Fundação Zerbini implementou vários programas de aperfeiçoamento institucional em áreas técnicas e humanas. Conseguiu a colaboração de inúmeros líderes da sociedade civil para a construção do InCor como entidade de excelência. O modelo de uma instituição público/privada serviu de inspiração para muitas outras instituições no país. O InCor pôde destinar, à época de sua chefia, 10% dos leitos para pacientes de convênios privados ou clientes particulares, que pagavam pelos bons serviços prestados pelos cardiologistas da instituição. Os outros 90% eram dedicados a pacientes do sistema público de saúde, que usufruíam da qualidade de ponta dos serviços do InCor, pela arrecadação obtida com convênios e particulares. Esse modelo gerencial flexível hoje se tornou uma referência para fundações e mantenedoras de hospitais pelo Brasil afora.Recebeu inúmeros Prêmios e distinções: Membro Titular da Academia Nacional de Medicina, Prêmio Fundação Conrado Wessel além de várias distinções acadêmicas de outras universidades. O Centro de Pesquisas do InCor tem o seu nome.Foi autor e co-autor de cerca de 480 artigos em revistas científicas nacionais e 233 em periódicos internacionais. Foi um visionário e conseguiu inspirar seus discípulos e colaboradores na missão de criar uma instituição – o InCor de alta qualidade e padrão internacional. Como ele mesmo declarou em seu último pronunciamento no InCor: “A chave da felicidade é sonhar. A chave do sucesso é tornar os sonhos uma realidade”.A medicina brasileira se despede de um de seus maiores ícones. Fica o exemplo de uma vida plena de realizações para a humanidade. De Fúlvio Pileggi se pode dizer que lutou a vida inteira e, portanto, merece ser qualificado segundo Bertolt Brecht:“Há homens que lutam um dia e são bons, há outros que lutam um ano e são melhores, há os que lutam muitos anos e são muito bons. Mas há os que lutam toda a vida e estes são imprescindíveis”.Charles MadyNo InCor, na Faculdade de Medicina da USP, no Hospital das Clínicas e nas sociedades médicas e civis, perdemos Fúlvio José Carlos Pileggi, personagem histórico e eminente. Ele possuía uma personalidade única, transparente e sincera, gostassem ou não. É fácil profissionalmente descrever um acadêmico, com todas as suas publicações e sua experiência de ensino. É mais difícil comentar sobre o ser humano, suas visões e pensamentos, que certamente são seu maior legado e que o levaram a desenvolver nosso instituto após as administrações de Zerbini e Décourt. Não deve ter sido fácil suceder a tais gigantes, mas Pileggi conseguiu elevar ainda mais o InCor. Todos nós temos virtudes e defeitos, mas, nesta balança, as virtudes irrefutavelmente predominaram. Tive, juntamente com muitos outros, o privilégio de conviver com ele quase diariamente, acompanhando de perto sua atuação enquanto liderava o InCor e, antes disso, na Segunda Clínica Médica, como Professor Assistente do Professor Décourt.Foi nesta ocasião, quando eu ainda era estudante do quarto ano, no ano 1968, que eu o conheci. Ele disse, brincando, que eu só andava com livro ou revista debaixo do braço. Passamos a discutir medicina com frequência e esse contato nos aproximou muito, mesmo durante o meu estágio, a residência e o ensino. Foi o período que mais aprendi e serviu de base para a minha formação como clínico geral e cardiologista. Os estudos de pós-graduação começavam no nível de mestrado e Pileggi me incentivou a realizar matrícula na primeira turma. Logo depois, ele me convidou para ser contratado como médico assistente e me colocou, junto com outros, no curso de doutorado; depois disso, nos acompanhou 24 horas por dia, querendo ser informado sobre o andamento de todas as atividades do instituto. Ele me instruiu a defender o ensino gratuito, sem que eu tivesse direto de argumentar com ele. Ele francamente me exigiu isso, e assim foi. Como não ser grato a essa pessoa que participou de forma tão ativa e construtiva na minha formação? Havia uma academia, uma equipe que, sob a sua orientação, levou o InCor ao auge, formando líderes interna e externamente, exigindo qualidade.Ele tinha paixão também por outra academia, o Palmeiras.Conhecia tudo e todos e era um grande líder. Ele exigiu resultados à sua maneira, amparado por uma equipe invejável, com Macruz, Tranchesi, Serro-Azul, Bellotti, Ebaid, Del Nero e muitos outros que estiveram ao seu lado. Sabia agregar quem produzia, conquistando o respeito de todos e valorizando o mérito. Ele era selvagem, como um bom descendente dos calabreses, gritando e esperneando, mas não era um homem de tristeza. Como um homem de sentimentos, superava qualquer agressividade. Naturalmente, nós tínhamos as nossas diferenças conceituais, mas foram logo resolvidas. A porta de seu escritório estava sempre aberta e recebia a todos mesmo sem hora marcada. Lagrimejavam-lhe os olhos quando ouvia seus tenores e barítonos italianos. Certa vez, em sua casa, ele chorou ao ouvir Giglio, após algumas taças de vinho, outra de suas paixões. Ele construíra uma adega invejável e era generoso em compartilhá-la. Em outra ocasião, durante um jantar em sua casa, na companhia de um pesquisador da Itália, ele nos ofereceu um Romanée-Conti e deu de presente uma garrafa de Château Lafite. Para os nossos almoços de quarta-feira, no restaurante Massimo, eu levava o melhor. Ele também era admirador da boa cozinha, e o anfitrião fazia questão de agradá-lo. Certa vez, relatou-nos emocionado que ao contar ao seu pai que havia passado no vestibular da USP em terceiro lugar, ele lhe perguntou, ‘Por que não entrou em primeiro?’ Exigências e exigente desde a infância.As rédeas do InCor sempre estavam em suas mãos, mesmo nos finais de semana e feriados. Ele foi movido pela paixão. Pessoas influentes sempre foram incentivadas a fazer doações ao instituto. Certa vez, depois de um banqueiro ter sigo operado na sua sala, ele pediu uma determinada quantia para a compra de equipamento. O paciente hesitou e Pileggi disse-lhe que, como seu médico, exigia a quantia, porque o hospital salvara-lhe a vida. Naquele exato momento, ele ligou para o banco para autorizar a transferência.Ele colocou o InCor acima de tudo, dizendo que ficava mais aqui do que em sua casa, porque também era sua casa. Este legado, este espírito acadêmico era, para mim, a coisa mais importante que ele adorava. Ele consistentemente usou sua considerável influência pelo bem desta casa. Ele raramente ficava desanimado em decorrência de algum acontecimento político e, quando isso acontecia, logo se levantava e voltava a produzir. Ele era avesso à mídia, nunca buscando sua atenção. Ao contrário, a mídia tentou alcançá-lo, sem sucesso.No seu concurso para Professor Titular, o tema escolhido foi “Pericardites”, sobre o qual ele havia ministrado uma aula de mestrado. Ele se aposentou aos setenta anos, desgostoso com certos fatos. Com grande dificuldade, conseguimos trazê-lo de volta, reunindo velhos amigos e gerando alegria a todos.Por tudo o que você conquistou, sempre terá um lugar de destaque na Medicina. Onde você estiver, saiba que o seu InCor guarda enorme respeito por você e você será sempre lembrado com saudade pelo inesquecível legado que deixou. Você fez a diferença, com coragem e determinação. Descanse em paz.Roberto Kalil FilhoO Prof. Fúlvio Pileggi fez sua especialização em Cardiologia no México, voltou ao Brasil e tornou-se uma grande referência na Cardiologia do país durante décadas. Ele foi, em conjunto com o Prof. Zerbini e o com o Prof. Décourt, um dos idealizadores do InCor do Hospital das Clínicas da Faculdade de Medicina da USP. O Prof. Pileggi orientou e liderou o desenvolvimento do InCor, edificando a instituição que é parte da rede pública universitária voltada para o atendimento dos pacientes, ensino e pesquisa, embasados no humanismo. O InCor divulgou-se nas suas áreas de atuação e propagou ensinamentos e formação de competências para a sociedade. Tive o privilégio de testemunhar a contribuição do Prof. Pileggi, que aglutinava a ajuda de muitos dos seus pares professores e também da sociedade. Associou-se posteriormente o Prof. Jatene com a sua reconhecida contribuição.A vida do Prof. Pileggi era este instituto.Presença diária, constante, mesmo nos feriados e finais de semana, era atento a cada detalhe da instituição. Um dos cuidados do Prof. Pileggi era a incorporação tempestiva das tecnologias mais modernas e mais avançadas. Frequentemente, designava pessoas para conhecerem no exterior novos desenvolvimentos de tecnologia. Graças ao Prof. Fúlvio Pileggi, liderando colegas professores e outros profissionais possibilitou-se que o InCor alcançasse a excelência na assistência aos pacientes, ensino e pesquisa. Era um grande clínico, muito dedicado aos seus pacientes, atento na maior parte do tempo às suas necessidades. Eu fui assistente do Prof. Pileggi por longo tempo e pude acompanhar a preocupação em atender os pacientes continuamente. Ele estudava muito, diariamente até tarde da noite e acompanhava a literatura médica de modo muito assíduo. Foi uma liderança de alta estatura humana, médica e científica e continua vivo no legado que edificou e nos deixou.Desse modo, o Prof. Pileggi permanece presente por meio de seus ensinamentos em todos nós. Nós o pressentimos em cada canto do hospital.Permanece também em nós grande reverência e gratidão ao distinto ser humano e Professor de Medicina. Carlos Eduardo RochitteHospital das Clínicas of the Faculty of Medicine of the University of São Paulo (USP). In the words of 3 people who were very close to him , we shall remember the career and the personality traits that characterized him as an undisputed leader for a generation of cardiologists. As a resident of InCor, I had the honor of meeting and interacting with Professor Pileggi, and he played a fundamental role in my academic career. First, there was apparently an obstacle to getting into a postgraduate program, “To enroll in a postgraduate program, you must have completed an internship abroad.” This, in association with the fact that nearly all scholarships to study abroad required, as a pre-requisite, that the applicant be enrolled in a postgraduate program, seemed to be an insurmountable barrier, which only served to stimulate me to look even harder for alternative ways to surmount it. And, in fact, he was the one who opened all the doors to make it possible for me to complete an internship at Johns Hopkins University. After that, the rest was history. I am eternally indebted to him for his teachings.In this special editorial, we would like to pay tribute to an icon of Brazilian Cardiology who was directly responsible for developing one of the greatest cardiology institutions in the world, The Heart Institute (InCor), at the Arquivos Brasileiros de Cardiologia (ABC Cardiol) and the scientific community as a whole, we would like to thank Professor Pileggi for all the contributions that he made, directly and indirectly, to the science of Cardiology. To give a brief overview, Professor Pileggi published, as author or co-author, 341 articles in ABC Cardiol, and InCor is currently the institution responsible for the highest number of publications in this journal.On behalf of the But let us hear from those who knew him best, in all of his diverse nuances.Protásio L. da Luz1 graduated from the USP Faculty of Medicine in 1947. He completed an internship at the Ignacio Chávez Institute of Cardiology in Mexico, as a postgraduate student of Cardiology. Upon his return to Brazil, he dedicated his entire academic career to the USP, constantly alongside Professor Luiz V. Décourt, whom he would eventually replace as Full Professor of Cardiology. He became the Director of InCor in 1982, a position which he would hold until 1997. Diverse facets of his character are worthy of mention. He had a strong, memorable personality; he was a critical thinker, with broad interests including sports and classical music; he became a notable wine connoisseur. He was constantly faithful to his countless friends, and he enjoyed exchanging points of view on any subject imaginable. His friendships included an array of politicians, businesspeople, lawyers, magistrates, and university colleagues, and he made no distinctions of race or gender. In all personal dealings, he was affable and respectful.Born in the city of São Carlos, São Paulo, Fúlvio José Carlos PileggiAs a doctor, he excelled in knowledge, good sense, and humanism. With his solid clinical background, he knew how to surround himself with specialists from new areas of Cardiology, in a manner that successfully combined the human aspects of the profession with technological advances in diagnosis and treatment. Guided by integrity, he always placed his patients’ interests above everything else. He treated important Brazilian figures, including presidents, the same way he treated everyday citizens. As a tireless scholar, he was always up-to-date. Thanks to these qualities, he founded an important private clinic, gaining his patients’ unconditional trust.As a university professor, he had an exceptionally distinguished academic career, giving absolute priority to competence, integrity, and dedication. He was one of the professors who fought hardest against the politicization of the universities, defending the idea that academic positions, for example, university deans, should be nominated by academic peers, rather than by individuals from the outside who did not participate in the university’s fundamental principles. He sought professional excellence in all branches of medicine, and he guided countless disciples whom he consistently stimulated, even after they graduated from USP. Singularly, he taught by example, more than by rhetoric.As a manager, he made InCor and USP his life goal. By creating full-time, well-paid careers in research, he brought scientists to the institute, in both basic areas and in physiology, genetics, molecular biology, immunology, and vascular biology, in addition to clinical research. This took InCor to a new level. It went from a primary care hospital to a research institute that produced knowledge. He was a demanding administrator, but he was understanding, informal, upright, and fair. He had a clear vision of the academic institution’s formative, groundbreaking role. Thus, he understood and implemented the concept wherein InCor was based on three pillars: teaching, care, and research. With respect to teaching, InCor has, for many years, prepared specialists on the highest levels of Cardiology, Pneumology, and Cardiac and Thoracic Surgery, with its master’s, doctorate, and specialization courses. Its undergraduate course is high-ranking, and it provides the basis that every doctor should have in Cardiology and Pneumology. With respect to care, he always sought to guarantee that InCor would provide the highest quality of diagnostic, therapeutic, psychological, social, nutritional, and other forms of care to all patients, both those covered by Brazil’s public Unified Health System (SUS) and those with private healthcare plans, regardless of race, gender, ideology, or religion. Through the Zerbini Foundation, he implemented several programs in technical and human areas. He was able to guarantee support from diverse leaders of civil society in order to build InCor as an entity of excellence. The institute’s public/private model has been a source of inspiration to many other institutions throughout Brazil. At the time of his leadership, InCor was able to allocate 10% of beds to patients with private healthcare plans or private patients who paid for the excellent services provided by the institute’s cardiologists. The other 90% of beds were reserved for patients from the SUS, who received InCor’s state-of-the-art services, made possible by funds obtained from private healthcare plans and private individuals. This flexible management model has, today, become a reference for foundations and hospital managers all around Brazil.He received countless awards and distinctions, including Full Member of the Brazilian National Academy of Medicine, the Conrado Wessel Foundation Award, and diverse academic distinctions from other universities. InCor’s Research Center was named after him.He was author or co-author of approximately 480 articles in Brazilian scientific journals and 233 articles in international journals. He was a visionary who managed to inspire his disciples and collaborators in the mission of creating a high-quality, world-class institution: InCor. As he himself stated in his final speech at InCor, “The key to happiness is dreaming. The key to success is making dreams come true ”While Brazilian medicine says goodbye to one of its greatest icons, his example of a life full of achievements on behalf of humanity remains. We can say of Fúlvio Pileggi that he fought throughout his entire life, and he, therefore, deserves to be described in the words of Bertolt Brecht:“There are men who fight for a day, and they are good. There are others who fight for a year, and they are better. There are those who fight many years, and they are very good, but there are those who fight their whole lives, and they are indispensable.”Charles MadyHospital das Clínicas, and medical and civil societies, we have lost Fúlvio José Carlos Pileggi, a remarkable, historical figure. He had a unique, transparent and sincere personality, whether other people liked it or not. It is easy to professionally describe an academic, with his publications and teaching experience. It is more difficult to comment on the human being, his visions and thoughts, which are certainly his greatest legacy and which led him to develop our institution after the Zerbini and Décourt administrations. It cannot have been easy to succeed two giants, but Pileggi managed to elevate InCor even higher. We all have virtues and defects, but, on this scale, virtues predominated overwhelmingly. I was, together with many, privileged to live with him on an almost daily basis, closely watching his performance as he led InCor, and, before that, at the Second Medical Clinic, as Assistant Professor to Professor Décourt.At InCor, the Faculty of Medicine of USP, the It was on that occasion, as a fourth year student, in 1968, that I met him and, he said, jokingly, that I went everywhere with a book or magazine under my arm. We started to discuss medicine frequently, and this contact brought us very close, even during my internship, residency, and teaching. It was the period that I learned the most, and it built the foundation of my training as a general practitioner and cardiologist. Postgraduate studies started at the master’s level, and Pileggi encouraged me to enroll in the first class. Soon after, he invited me to be hired as an assistant doctor, and placed me, along with others, in the doctorate course; after that, he followed us around the clock, wanting to be informed regarding the progress of all activities at the institution. He instructed me to defend free teaching, without waiting for an answer. He simply told me to do it, and so I did. How can I not be grateful to someone who participated actively, constructively, in my training? There was an academy, a team that, under his guidance, led InCor to its peak, forming leaders internally and externally, demanding quality.He was also passionate about another team, the Brazilian football club Palmeiras.He knew everyone and everything, and he was a great leader. He demanded results in his own way, aided by an enviable team, with Macruz, Tranchesi, Serro-Azul, Bellotti, Ebaid, Del Nero, and many others standing by his side. He aggregated those who produced, receiving the respect of all, valuing merit. He was wild, like a good descendant of Calabrians, kicking and screaming, but he was not a man of sorrows. As a heartfelt man, he overcame any aggressiveness. We naturally had our conceptual differences, but they were soon resolved. The door to his office was always open, and he welcomed everyone without an appointment. He came to tears, listening to his Italian tenors and baritones. Once, at home, he cried when he heard Giglio after a few glasses of wine, another of his passions. He built an enviable wine cellar, and he was generous in sharing it. Another time, at dinner at his home, in the company of an Italian researcher, he offered us a Romanée-Conti and gave him a bottle of Château Lafite as a present. For our Wednesday lunches, at the Massimo restaurant, I brought the best. He was also an admirer of fine cuisine, and the host made a point of pleasing him. Once, he told us with emotion, his told his father that he had placed third in the USP entrance exam, to which his father replied, “Why weren’t you first?” Demands and demanding since childhood.InCor’s reins were always in his hands, even on weekends and holidays. He was driven by passion. Influential people were always urged to make donations to the institute. Once, after a banker had undergone surgery in his office, he requested a certain amount for the purchase of equipment. The patient hesitated, and Pileggi told him that, as his doctor, he demanded the sum, because the hospital had saved his life. That very moment, he called the bank to authorize the transfer.He put InCor above all else, saying that he stayed here more than at his home, because it was also his home. This legacy, this academic spirit was, for me, the most important thing he worshipped. He consistently used his considerable influence for the sake of this house. He was rarely discouraged as a result of any political events, and, when he was, he would soon get up and start producing again. He was averse to the media, never seeking their attention. On the contrary, the media attempted to reach him, without success.In his competitive exam for Full Professor, the chosen theme was “Pericardites”, on which he had taught a master’s class. He retired at the age of seventy, disgusted with certain facts. With great difficulty, we managed to bring him back, reuniting old friends and bringing joy to everyone.For all that you have accomplished, you will always hold a prominent place in Medicine. Wherever you are, know that your InCor has enormous respect for you, and that you will always be lovingly remembered for the unforgettable legacy you have left. You made a difference, with courage and determination. Rest in peace.Roberto Kalil FilhoHospital das Clínicas of the USP Faculty of Medicine. Professor Pileggi guided and led the development of InCor, building the institute that is part of the public network of university hospitals dedicated to patient care, teaching, and research, based on humanism. InCor branched out into the areas in which it now acts, and it disseminated teaching and skilled training throughout society. I had the privilege of witnessing Professor Pileggi’s contributions, as he united his peers, professors, and society as well. He later reached out to Professor Jatene, with his well-known contribution.Professor Fúlvio Pileggi completed his specialization in Cardiology in Mexico. When he returned to Brazil, he became a major reference in Cardiology for decades. Together with Professor Zerbini and Professor Décourt, he was one of the founders of InCor at the This institute was his life.As a daily and constant presence, even on weekends and holidays, he was attentive to every detail of the institute. One of Professor Pileggi’s concerns was the timely implementation of the most modern and advanced pieces of technology. He would frequently appoint people to go abroad to discover new technological developments. Professor Fúlvio Pileggi’s leadership of colleagues, professors, and other professionals, made it possible for InCor to achieve excellence in patient care, teaching, and research. He was an excellent physician who was very dedicated to his patients, and he was always attentive to their needs. As Professor Pileggi’s assistant for a long time, I was able to follow his concerns in continually providing care for patients. He studied hard, on a daily basis, until late at night, assiduously staying up-to-date on medical literature. He was an outstanding human being, doctor, and scientist, and he is still alive in the legacy that he built and left us.In this manner, Professor Pileggi is still with all of us in his teachings. We can feel his presence in every corner of the hospital.Our great reverence and gratitude to the distinguished human being and Professor of Medicine likewise endure.