The American College of Chest Physicians (ACCP) published a guideline recommending a minimum competency number for 17 interventional pulmonary procedures. Our aim is to assess what procedures are offered to fellows and to determine if recommended competency numbers are met.
Surveys were mailed to 122 pulmonary /critical care fellowships in the U.S. Fellowship demographics, types of procedures offered, and the average number of procedures performed were recorded.
The response rate was 68%. The presence of an interventional pulmonologist was associated with increased likelihood of advanced procedural training in brachytherapy (p<0.01), electrocautery/argon plasma coagulation (p<0.001), stents (p<0.001), laser therapy (p<0.01), rigid bronchoscopy (p<0.01), cryotherapy (p<0.05). Table 1ProcedurePercentage of Programs Offering the ProcedureACCP Recommended Competency NumberPercentage of Programs Reaching Competency NumberFlexible bronchoscopy100%10095%Tube thoracostomy100%1065%Transbronchial needle94%2565%Airway stents48%207%Electrocautery37%156%Laser therapy27%156%Transthoracic Needle30%1012%Percutaneous tracheostomy29%208%: Selected procedures offered and percentage of programs achieving competency numbers.
(1)There is large variation in the spectrum of pulmonary procedures offered to trainees. (2)Programs with a dedicated interventional pulmonologist are more likely to offer training in advanced therapeutic procedures. (3)Less than 40% of programs that offered training in advanced therapeutic procedures met the competency recommendations.
(1)To reach the recommended competency numbers, an extra year of interventional training could be considered. (2)An alternative to recommending competency numbers for select procedures would be regionalizing care at centers which perform many procedures. (3)To provide justification for current competency recommendations, clinical outcomes should be correlated with physicians’ procedural volume.
N.J. Pastis, None.