Training in Interventional Pulmonology

Abstract

The field of interventional pulmonology (IP) is a rapidly growing subspecialty of pulmonary and critical care medicine (PCCM), primarily focused on the evaluation and management of patients with lung nodules, masses, mediastinal and hilar adenopathy, central airway obstruction, and pleural disease. Traditionally passed on in the apprenticeship model, dedicated fellowships began in the early 2000s and there are currently approximately 24 IP fellowships throughout the United States. In addition to the evaluation and management of patients with the above diseases, the additional year provides training in advanced diagnostic and minimally invasive therapeutic procedures that are not specifically taught during a standard PCCM fellowship. This article will review the evolution of the field of IP as well as the pathways to learn advanced procedural techniques.

Keywords

interventional pulmonology - bronchoscopy - training - education

• References

• 1 Seijo LM, Sterman DH. Interventional pulmonology. N Engl J Med 2001; 344 (10) 740-749
• 2 Killian G. Ueber direkte Bronchoskopie. Muench Med Wochen 1898; 27: 844-847
• 3 Dumon JF. A dedicated tracheobronchial stent. Chest 1990; 97 (2) 328-332
• 4 Prakash UB, Offord KP, Stubbs SE. Bronchoscopy in North America: the ACCP survey. Chest 1991; 100 (6) 1668-1675
• 5 Haponik EF, Shure D. Underutilization of transbronchial needle aspiration: experiences of current pulmonary fellows. Chest 1997; 112 (1) 251-253
• 6 Tape TG, Blank LL, Wigton RS. Procedural skills of practicing pulmonologists. A national survey of 1,000 members of the American College of Physicians. Am J Respir Crit Care Med 1995; 151 (2, Pt 1) 282-287
• 7 Feller-Kopman D. Is a Dedicated 12-Month Training Program Required in Interventional Pulmonology?. Journal of Bronchology 2004; 11: 62-64
• 8 Coleman JJ, Esposito TJ, Rozycki GS, Feliciano DV. Early subspecialization and perceived competence in surgical training: are residents ready?. J Am Coll Surg 2013; 216 (4) 764-771 , discussion 771–773
• 9 Ernst A, Silvestri GA, Johnstone D ; American College of Chest Physicians. Interventional pulmonary procedures: Guidelines from the American College of Chest Physicians. Chest 2003; 123 (5) 1693-1717
• 10 Pastis NJ, Nietert PJ, Silvestri GA ; American College of Chest Physicians Interventional Chest/Diagnostic Procedures Network Steering Committee. Variation in training for interventional pulmonary procedures among US pulmonary/critical care fellowships: a survey of fellowship directors. Chest 2005; 127 (5) 1614-1621
• 11 Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med 2003; 349 (22) 2117-2127
• 12 Hannan EL, Racz MJ, Walford G , et al. Predictors of readmission for complications of coronary artery bypass graft surgery. JAMA 2003; 290 (6) 773-780
• 13 Pilot Certification in the United States. Wikipedia, 2014. Available at: http://en.wikipedia.org/wiki/Pilot_certification_in_the_United_States . Accessed August 1, 2014
• 14 Sznajder JI, Zveibil FR, Bitterman H, Weiner P, Bursztein S. Central vein catheterization. Failure and complication rates by three percutaneous approaches. Arch Intern Med 1986; 146 (2) 259-261
• 15 Gladwell M. The Tipping Point. New York: Little Brown & Company; 2002
• 16 Kemp SV, El Batrawy SH, Harrison RN , et al. Learning curves for endobronchial ultrasound using cusum analysis. Thorax 2010; 65 (6) 534-538
• 17 Watkins JL, Etzkorn KP, Wiley TE, DeGuzman L, Harig JM. Assessment of technical competence during ERCP training. Gastrointest Endosc 1996; 44 (4) 411-415
• 18 Jowell PS. Endoscopic retrograde cholangiopancreatography: toward a better understanding of competence. Endoscopy 1999; 31 (9) 755-757
• 19 American Board of Internal Medicine. Interventional Cardiology Policies. American Board of Internal Medicine, 2014. Available at: http://www.abim.org/certification/policies/imss/icard.aspx . Accessed August 1, 2014
• 20 American Board of Internal Medicine. Clinical Cardiac Electrophysiology Policies. American Board of Internal Medicine, 2014. Available at: http://www.abim.org/certification/policies/imss/ccep.aspx . Accessed August 1, 2014
• 21 American Board of Internal Medicine. Internal Medicine Policies. American Board of Internal Medicine, 2014. Available at: http://www.abim.org/certification/policies/imss/im.aspx . Accessed August 1, 2014
• 22 Feller-Kopman DJ, Brigham E, Lechtzin N, Gilbert C, Akulian J, Yarmus L. Training perspective: the impact of starting an endobronchial ultrasound program at a major academic center on fellows training of transbronchial needle aspiration. Ann Am Thorac Soc 2013; 10 (2) 127-130
• 23 Tanner NT, Pastis NJ, Silvestri GA. Training for linear endobronchial ultrasound among US pulmonary/critical care fellowships: a survey of fellowship directors. Chest 2013; 143 (2) 423-428
• 24 Huang GC, Smith CC, Gordon CE , et al. Beyond the comfort zone: residents assess their comfort performing inpatient medical procedures. Am J Med 2006; 119 (1) e17-e24
• 25 Huang GC, Newman LR, Schwartzstein RM , et al. Procedural competence in internal medicine residents: validity of a central venous catheter insertion assessment instrument. Acad Med 2009; 84 (8) 1127-1134
• 26 Smith CC, Gordon CE, Feller-Kopman D , et al. Creation of an innovative inpatient medical procedure service and a method to evaluate house staff competency. J Gen Intern Med 2004; 19 (5 Pt 2) 510-513
• 27 Duncan DR, Morgenthaler TI, Ryu JH, Daniels CE. Reducing iatrogenic risk in thoracentesis: establishing best practice via experiential training in a zero-risk environment. Chest 2009; 135 (5) 1315-1320
• 28 SAGES. Guidelines for Training in Diagnostic and Therapeutic Endoscopic Retrograde Cholangiopancreatography (ERCP). Society of American Gastrointestinal and Endoscopic Surgeons, 2014. Available at: http://www.sages.org/publications/guidelines/guidelines-for-training-in-diagnostic-and-therapeutic-endoscopic-retrograde-cholangiopancreatography-ercp/ . Accessed August 1, 2014
• 29 Colt HG, Prakash UBS, Offord KP. Bronchoscopy in North America: survey by the American Association for Bronchology, 1999. Journal of Bronchology 2000; 7: 8-25
• 30 Lamb CR, Feller-Kopman D, Ernst A , et al. An approach to interventional pulmonary fellowship training. Chest 2010; 137 (1) 195-199
• 31 Lee HJ, Feller-Kopman D, Shepherd RW , et al. Validation of an interventional pulmonary examination. Chest 2013; 143 (6) 1667-1670
• 32 Yarmus L, Feller-Kopman D, Imad M, Kim S, Lee HJ. Procedural volume and structure of interventional pulmonary fellowships: a survey of fellows and fellowship program directors. Chest 2013; 144 (3) 935-939
• 33 Bolliger CT, Mathur PN, Beamis JF , et al; European Respiratory Society/American Thoracic Society. ERS/ATS statement on interventional pulmonology. Eur Respir J 2002; 19 (2) 356-373
• 34 Holmboe ES, Wang Y, Meehan TP , et al. Association between maintenance of certification examination scores and quality of care for Medicare beneficiaries. Arch Intern Med 2008; 168 (13) 1396-1403
• 35 Reznick RK, MacRae H. Teaching surgical skills—changes in the wind. N Engl J Med 2006; 355 (25) 2664-2669
• 36 Davoudi M, Colt HG, Osann KE, Lamb CR, Mullon JJ. Endobronchial ultrasound skills and tasks assessment tool: assessing the validity evidence for a test of endobronchial ultrasound-guided transbronchial needle aspiration operator skill. Am J Respir Crit Care Med 2012; 186 (8) 773-779
• 37 Martin JA, Regehr G, Reznick R , et al. Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 1997; 84 (2) 273-278