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Variation in Training for Interventional Pulmonary Procedures Among US Pulmonary/Critical Care Fellowships^*

A Survey of Fellowship Directors

Nicholas J. Pastis, MD; Paul J. Nietert, PhD; Gerard A. Silvestri, MD, FCCP; for the American College of Chest Physicians Interventional Chest/Diagnostic Procedures Network Steering Committee

^* From the Departments of Medicine (Drs. Pastis and Silvestri) and Biostatistics and Bioinformatics (Dr. Nietert) at the Medical University of South Carolina, Charleston, SC. A list of the ACCP Interventional Chest/Diagnostic Procedures Network Steering Committee is located in ^{Appendix 1}.

Correspondence to: Gerard A. Silvestri, MD, FCCP, Medical University of South Carolina, Suite 812-CSB, 96 Jonathan Lucas St, PO Box 250630, Charleston, SC 29425; e-mail: silvestri{at}musc.edu

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.

Key Words: bronchoscopy • fellowship training • interventional procedures • interventional pulmonology

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