Affiliations: Beth Israel Medical Center, New York, NY,
University of Saskatchewan, Saskatchewan, Canada,
Johns Hopkins University School of Medicine, Baltimore, MD,
University of California at San Diego, San Diego, CA, For the Pulmonary Physiology, Function, and Rehabilitation NetWork of the ACCP
Correspondence to: Steven H. Salzman, MD, FCCP, Beth Israel Medical Center, Pulmonary and Critical Care Medicine, 7 Dazian Building, First Ave at 16th St, New York, NY 10003; e-mail: firstname.lastname@example.org
As pulmonary medicine has grown to include critical care and sleep, fellowship training in the pulmonary function laboratory and physiology has diminished.1–5 The Pulmonary Physiology, Function, and Rehabilitation Network surveyed American College of Chest Physicians members to assess the perceived quality of training in physiology.
Of the 637 respondents (18% of surveyed), 30.6% believed that current training in pulmonary physiology was only “fair” or “inadequate” (dissatisfied group). Respondents were more likely to be dissatisfied if in practice < 20 years (33.9% vs 23.4%) [p < 0.03], taught fellows (37.7% vs 23.0%) [p < 0.01], were university based (38.4% vs 24.1%) [p < 0.03], or did not supervise a pulmonary function testing laboratory (34.7% vs 22.1%) [p < 0.01].
shows the training quality ratings for 16 clinical areas (columns A and F), importance to current position (column B), and three measures of priorities for training improvement (columns C, D, and E). The quality of training in clinical aspects (column A) was higher than for technical aspects (column F). Areas most important in current position (column B) were also rated highest for training quality (columns A and F). Conversely, subject areas of least importance to current position were least well trained. While this initially suggests appropriate emphasis, a physician is less likely to practice techniques for which they are not well trained.
Priorities for training improvement (columns C to E) are clustered in two areas: (1) areas less well trained during fellowship and less important in current position (sleep, rehabilitation, cardiopulmonary exercise testing); and (2) clinical areas most important in current position and most well trained (ventilator management, spirometry, blood gases, bronchoscopy). This suggests that pulmonologists want to learn more about areas they do most (even if already well trained) but also areas they do least (but see potential for being valuable) and do not know much about.
In conclusion, there is significant dissatisfaction and deficiency with current training in pulmonary physiology. The dissatisfaction is more widespread in those who do the training and in those more recently trained, but all subgroups had a significant minority also dissatisfied. We must develop efficient ways to improve training in clinical pulmonary physiology given the many competing training needs during pulmonary, critical care and sleep fellowships.2–5
The authors have no conflicts of interest to disclose other than being faculty members in fellowship training programs in pulmonary and critical care medicine whose interests are in the areas of pulmonary physiology, exercise, and rehabilitation.
1 = inadequate, 2 = fair, 3 = adequate, 4 = good, and 5 = excellent.
Subjects were asked, “If you could improve the quality of training for current trainees in five of the areas, which would you choose? Please choose only five, and rank 1 through 5 with 1 being your first choice.” This column indicates the percentage of respondents including the clinical area among their top five.
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