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doi:10.1378/chest.07-0049
(Chest. 2007; 131:1270-1271)
© 2007 American College of Chest Physicians
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Survey on Quality of Training in Pulmonary Physiology During Fellowship

Steven H. Salzman, MD, FCCP; Darcy D. Marciniuk, MD, FCCP; Robert A. Wise, MD, FCCP and Andrew L. Ries, MD, FCCP

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: ssalzman{at}chpnet.org

To the Editor:

As pulmonary medicine has grown to include critical care and sleep, fellowship training in the pulmonary function laboratory and physiology has diminished.12345 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].

Table 1 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.


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  		Table 1.. Rating of Clinical Areas for Quality of Training During Fellowship, Importance in Current Work Position, and Priority for Improvement in Training

 
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.2345

Footnotes

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.

References

  1. Stevens, R (1986) Issues for American internal medicine through the last century. Ann Intern Med 105,592-602[ISI][Medline]
  2. Tobin, MJ Pulmonary and critical care medicine: a peculiarly American hybrid. Thorax 1999;54,286-287[Free Full Text]
  3. Phillips, B, Collop, N, Goldberg, R Sleep medicine practices, training, and attitudes: a wake-up call for pulmonologists. Chest 2000;117,1603-1607[CrossRef][ISI][Medline]
  4. Angus, DC, Kelley, MA, Schmitz, RJ, et al Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population. JAMA 2000;284,2762-2770[Abstract/Free Full Text]
  5. Kvale, PA, Wagner, PD, Epstein, LJ Pulmonary physicians in the practice of sleep medicine. Chest 2005;128,3788-3790[CrossRef][ISI][Medline]




This Article
Right arrow Full Text (PDF) Free
Right arrow Correction (v132,p738)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
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Services
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Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
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Right arrow Add to My Personal Article Archive
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Citing Articles
Right arrow Citing Articles via ISI Web of Science (1)
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Google Scholar
Right arrow Articles by Salzman, S. H.
Right arrow Articles by Ries, A. L.
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PubMed
Right arrow PubMed Citation
Right arrow Articles by Salzman, S. H.
Right arrow Articles by Ries, A. L.

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