Chest
Volume 127, Issue 5, May 2005, Pages 1614-1621
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Clinical Investigations
Variation in Training for Interventional Pulmonary Procedures Among US Pulmonary/Critical Care Fellowships: A Survey of Fellowship Directors

https://doi.org/10.1378/chest.127.5.1614Get rights and content

Study objectives

The American College of Chest Physicians has published guidelines recommending minimum competency requirements for 17 interventional pulmonary procedures. Our aim was to assess what procedures are offered to fellows in US pulmonary/critical care fellowships and to determine whether the recommended competency numbers are being met.

Methods

Surveys were mailed to 122 pulmonary/critical care fellowship directors in the United States, and fellowship demographics, the types of procedures offered, and the average number of procedures performed were recorded. The presence of a dedicated interventional pulmonologist (IP) was ascertained, and procedural offerings and volume were compared with programs that did not have an IP.

Results

The response rate of the survey was 77%. There was wide variation in the procedures offered by different programs. The presence of an IP was associated with an increased likelihood of advanced procedural training in brachytherapy (p < 0.05), electrocautery/argon plasma coagulation (p < 0.001), stents (p < 0.001), laser therapy (p < 0.01), rigid bronchoscopy (p < 0.001), and cryotherapy (p < 0.05). For only 3 of the 17 procedures did > 50% of the programs reach the targeted numbers to obtain competency.

Conclusions

There is a large variation in the spectrum of pulmonary procedures offered to trainees. Programs with a dedicated IP are more likely to offer training in advanced therapeutic procedures. When interventional procedures are offered by fellowships, < 30% of programs meet the competency recommendations. These findings have implications for training, delivery of care, and research. An extra year of fellowship in interventional pulmonology might be desirable if one is to reach the desired competency numbers. An alternative to reaching the recommended numbers for select procedures would be to consider regionalizing care at centers that perform many procedures. Finally, to provide justification for the current competency recommendations, clinical outcomes should be correlated with physicians' procedural volume, as has been done in other subspecialties.

Section snippets

Materials and Methods

A survey was developed by a survey research unit at the Medical University of South Carolina with assistance from the ACCP Interventional Chest/Diagnostic Procedures NetWork Steering Committee. The survey consisted of a list of interventional pulmonary procedures and asked whether each procedure was offered. If offered, the average number of procedures performed was recorded based on averages from either the 2002 or 2003 graduating class. In addition, there were 12 other questions concerning

Results

Surveys were mailed to 122 pulmonary/critical care fellowship programs within the United States. A total of 94 program directors responded (overall response rate, 77%) with 93 answering all questions regarding procedure numbers. Table 1 depicts the procedures offered, the percentage of fellows reaching competence, and the median number of procedures performed, and compares those to the competency numbers recommended by the ACCP. From Table 1, it can be seen that the numbers of procedures to be

Discussion

This study has four important findings. First, aside from routine diagnostic procedures such as flexible bronchoscopy, there is a large variation in what is offered to fellows in training. Second, most fellowship programs do not reach the recommended competency numbers recommended by the ACCP Interventional Chest/Diagnostic Procedures NetWork Steering Committee. Third, the presence of an IP is associated with offering more procedures for fellows. Finally, program directors did not agree on the

Appendix

ACCP Interventional Chest/Diagnostic Procedures Network Steering Committee

Armin Ernst, MD, FCCP; Neri Cohen, MD, FCCP; Heinrich D. Becker, MD, FCCP; Gordon H. Downie, MD, FCCP; John A. Howington, MD, FCCP; Atul C. Mehta, MBBS, FCCP; Leonard C. Moses, MD, FCCP; W. Roy Smythe, MD, FCCP; Stephen C. Yang, MD, FCCP; and David W. Johnstone, MD, FCCP.

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A list of the ACCP Interventional Chest/Diagnostic Procedures Network Steering Committee is located in Appendix 1.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestjournal.org/misc/reprints.shtml).

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