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Correspondence |

Standardization of Interventional Pulmonology Training FREE TO VIEW

Edmundo R. Rubio, MD, FCCP; Michael B. Boyd, MD, FCCP
Author and Funding Information

From the Section of Pulmonary Medicine, Interventional Pulmonology, Virginia Tech Carilion School of Medicine.

Correspondence to: Edmundo R. Rubio, MD, FCCP, Virginia Tech Carilion School of Medicine, 1906 Bellevue Ave, Ste 320, Roanoke, VA 24018; e-mail: errubio@carilionclinic.org


Financial/nonfinancial disclosure: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


© 2010 American College of Chest Physicians


Chest. 2010;138(3):761. doi:10.1378/chest.10-0849
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To the Editor:

We thank Lamb and colleagues1 for their recent article in CHEST (January 2010) addressing the need to standardize the training of interventional pulmonologists. We also appreciate the corresponding editorial by Ost et al2 that provided additional points of discussion. We agree that setting up strict criteria regarding the volume of procedures required may significantly limit the availability of these techniques to our patients. Many formally trained interventional pulmonologists have not met all the suggested standards, and current interventional pulmonary programs may close if unable to meet strict volume requirements. Additionally, we put forth that some procedures considered to be “interventional” perhaps should be part of the training of every general pulmonologist. For instance, in our fellowship program, we strive to train all our fellows to use endobronchial ultrasonography and to perform balloon bronchoplasty. We believe that learning curves are highly individualized and, hence, that the final decision to certify an individual to perform a procedure should be left to the program director and not be limited to procedure volumes.

We believe that certain interventions can be performed by pulmonologists who may be qualified to perform a particular procedure but not the whole scope of all available interventions. However, we also maintain that when dealing with more complicated patient airways, care should occur within a center capable of performing all foreseeable interventions.

We agree that short, 1- or 2-day interventional pulmonary courses should not be considered sufficient for training. Nevertheless, such courses that also are aimed at the general pulmonologist have become common and often include hands-on practice sessions. We need to make sure that we are not sending a contradictory message. We see their value as a way to disseminate the understanding of the available therapies and to improve patient access and referral. Such courses also serve to update the practicing interventional pulmonologist. With regard to the general practicing pulmonologist, these courses should perhaps emphasize training to deal with airway emergencies, such as the removal of foreign bodies.

Clearly, there is no consensus on the need to have strict interventional pulmonary fellowship programs. Regardless, as a profession, we must strive to provide our patients with the best possible care. Further, we must all remain aware of our limitations and refer our patients to where they can be treated with the best and safest approach. We welcome and commend our colleagues for bringing up these interesting issues.

Lamb CR, Feller-Kopman D, Ernst A, et al. An approach to interventional pulmonary fellowship training. Chest. 2010;1371:195-199. [CrossRef] [PubMed]
 
Ost D, Eapen GA, Jimenez CA, Morice RC. Improving procedural training and certification in pulmonary medicine. Chest. 2010;1371:6-8. [CrossRef] [PubMed]
 

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References

Lamb CR, Feller-Kopman D, Ernst A, et al. An approach to interventional pulmonary fellowship training. Chest. 2010;1371:195-199. [CrossRef] [PubMed]
 
Ost D, Eapen GA, Jimenez CA, Morice RC. Improving procedural training and certification in pulmonary medicine. Chest. 2010;1371:6-8. [CrossRef] [PubMed]
 
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