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Corcoran A, Shore D, Boesch RP, Chopra M, Das S, DiBardino D, Goldfarb S, Haas A, Hysinger E, Phinizy P, Vicencio A, Toth J, Piccione J. Practices and perspectives on advanced diagnostic and interventional bronchoscopy among pediatric pulmonologists in the United States. Pediatr Pulmonol 2024; 59:1708-1715. [PMID: 38558404 DOI: 10.1002/ppul.26977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/18/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Advanced diagnostic bronchoscopy includes endobronchial ultrasound (EBUS) guided transbronchial lung and lymph node biopsies, CT navigation and robotic bronchoscopy. Interventional bronchoscopy refers to procedures performed for therapeutic purposes such as balloon dilation of the airway, tissue debulking, cryotherapy, removal of foreign bodies and insertion of endobronchial valves [1]. For adult patients, these procedures are standard of care [2, 3]. Despite a lack of formalized training, there are numerous case reports and case series describing the use of advanced diagnostic and interventional bronchoscopy techniques in children. The safety and feasibility of EBUS-TBNA, cryotherapy techniques, endobronchial valves among other techniques have been demonstrated in these publications [1, 4-9]. METHODS We sought to better understand the current practices and perspectives on interventional and advanced bronchoscopy among pediatric pulmonologists through surveys sent to pediatric teaching hospitals across the United States. RESULTS We received 43 responses representing 28 programs from 25 states. The highest bronchoscopy procedure volume occurred in the 0-5 years age group. Among our respondents, 31% self-identified as a pediatric interventional/advanced bronchoscopist. 79% believe that advanced and interventional training is feasible in pediatric pulmonology and 77% believe it should be offered to pediatric pulmonary fellows. DISCUSSION This is the first study to characterize current practices and perspectives regarding advanced diagnostic and interventional bronchoscopy procedures among pediatric pulmonologists in the United States. Pediatric interventional pulmonology (IP) is in its infancy and its beginnings echo those of the adult IP where only certain centers were performing these procedures.
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Affiliation(s)
- A Corcoran
- Division of Pulmonary and sleep medicine, Children's Hospital Of Philadelphia, Philadelphia, PA
| | - D Shore
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - R P Boesch
- Mayo Clinic, Children's Center, Pediatric and Adolescent Medicine, Rochester, Minnesota
| | - M Chopra
- Division of Pulmonary, The University of Arizona, Tucson, Arizona
| | - S Das
- Section of Pediatric Pulmonary Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - D DiBardino
- Division of Pulmonary, Allergy, and Critical Care Medicine Perelman School of Medicine, University of Pennsylvania Philadelphia, PA
| | - S Goldfarb
- Division of Pulmonary and Sleep Medicine, University of Minnesota, Masonic Children's Hospital, Minneapolis, Minnesota
| | - A Haas
- Division of Pulmonary, Allergy, and Critical Care Medicine Perelman School of Medicine, University of Pennsylvania Philadelphia, PA
| | - E Hysinger
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - P Phinizy
- Division of Pulmonary and sleep medicine, Children's Hospital Of Philadelphia, Philadelphia, PA
| | - A Vicencio
- Division of Pulmonary Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - J Toth
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - J Piccione
- Division of Pulmonary and sleep medicine, Children's Hospital Of Philadelphia, Philadelphia, PA
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New ML, Amass T, Neumeier A, Huie TJ. Massive Hemoptysis Simulation Curriculum Improves Performance. Chest 2024; 165:645-652. [PMID: 37852435 DOI: 10.1016/j.chest.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Massive hemoptysis is a rare, high-acuity presentation, which requires the integration of both cognitive and procedural skills. Simulation has been recommended to improve preparation for high-acuity, low-occurrence procedures; however, the effect of a simulation curriculum for massive hemoptysis management has never been investigated. RESEARCH QUESTION Does simulation for hemoptysis management improve competence? STUDY DESIGN AND METHODS Kern's six steps for medical education curriculum design were used iteratively to develop a simulation curriculum for the management of massive hemoptysis. Pulmonary and critical care medicine fellows from the University of Colorado participated in a local needs assessment and a massive hemoptysis simulation curriculum. Using a manikin-based massive hemoptysis simulator developed for this curriculum, the simulation session used repetitive practice, clinical variation, a range of difficulties, and directed feedback in a group practice setting. Time to management and performance were assessed for each management attempt; competence was assessed using a combined metric of management-related priorities and global entrustment. RESULTS During the needs assessment, fellows viewed massive hemoptysis management skills as important, while expressing their current confidence as low. Nineteen fellows participated in a 90-min case-based hemoptysis simulation during which each was exposed to five different cases and acted as the primary manager for two cases. There was significant improvement in performance from the first to final simulation attempts measured by time to successful management (14.24 vs 10.26 min, P = .0067) and entrustment (Global Assessment Scale, 1 [should not perform] to 5 [independent]; 4.11 vs 4.61; P = .015). Fellow self-assessed knowledge and confidence in hemoptysis management and endobronchial blocker placement improved significantly after the simulation. INTERPRETATION Hemoptysis simulation experience improves fellow confidence and skill for management of this high-acuity, low-occurrence presentation.
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Affiliation(s)
- Melissa L New
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO; Rocky Mountain Regional VA Medical Center, Aurora, CO.
| | - Timothy Amass
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO; Denver Health Medical Center, Denver, CO
| | - Anna Neumeier
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO; Denver Health Medical Center, Denver, CO
| | - Tristan J Huie
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO; National Jewish Health, Denver, CO
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Lamb C, Sachdeva A. Training in interventional pulmonology: a leap into the future. Curr Opin Pulm Med 2024; 30:195-199. [PMID: 38197436 DOI: 10.1097/mcp.0000000000001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
PURPOSE OF REVIEW This review holds significant relevance and is timely; as of June 2022, the United States Accreditation Council of Graduate Medical Education (ACGME) formally recognized interventional pulmonary medicine as a novel subspecialty with a unique fellowship training program pathway beyond Pulmonary and Critical Care Medicine. This recognition stands as a culmination of extensive efforts spanning decades, aimed at establishing a specialized training program for interventional pulmonary medicine beyond traditional Pulmonary and Critical Care Fellowship in the United States. Globally, there are apprenticeship models in non-US programs with ongoing efforts to further standardize training in interventional pulmonary medicine. It underscores the progressive evolution and innovative nature inherent to this subspecialty, signifying a distinctive leap forward in medical education and practice, which calls for further inventive development of training tools and standardized educational delivery. RECENT FINDINGS Newly discovered insights from the recent literature review will highlight methodologies of procedural education and innovative training approaches. These findings will underscore the significance of standardized curriculum development within the field as well as ongoing challenges. SUMMARY Identifying and addressing future challenges in integrating new technologies into clinical education and broadening the educational scope of trainees in this newly recognized subspecialty is crucial for enhancing competency. The implications of moving toward a more standardized process, creating new clinical pathways with research, and adopting emerging minimally invasive technologies aim to impact patient outcomes in both nonmalignant and malignant thoracic diseases. This progressive shift is redefining the specialty, moving beyond specific procedures, and pivoting towards a more distinct educational pathway. Such a transformation will lead to more diverse, comprehensive, and evidence-based driven patient care delivery.
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Affiliation(s)
- Carla Lamb
- Lahey Hospital and Medical Center, Tufts University, Burlington, Massachusetts
| | - Ash Sachdeva
- University of Maryland, Baltimore, Maryland, USA
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Lee HJ, Akulian JA, Argento AC, Batra H, Lamb C, Mullon J, Murgu S. Interventional Pulmonary Fellowship Training: End of the Beginning. ATS Sch 2023; 4:405-412. [PMID: 38196682 PMCID: PMC10773264 DOI: 10.34197/ats-scholar.2022-0107ps] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 06/23/2023] [Indexed: 01/11/2024] Open
Abstract
Interventional pulmonology (IP) fellowship training has undergone increased popularity and growth. The Accreditation Council of Graduate Medical Education recently recognized IP medicine as a new subspecialty, which leads to new challenges and opportunities for a young subspecialty. Although the specialty-specific requirements are in progress, IP fellowship programs must plan ahead for the known common program requirements and anticipated accreditation process. The educational leadership in IP must identify and execute solutions to sustain continued excellence. This includes transitioning to a new regulatory environment with issues of funding new fellowships, keeping up to date with training/assessment of new procedures, and shaping the future through recruitment of talent to lead the young subspecialty.
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Affiliation(s)
- Hans J. Lee
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jason A. Akulian
- Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - A. Christine Argento
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hitesh Batra
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Carla Lamb
- Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - John Mullon
- Division of Pulmonary, Critical Care, and Sleep Medicine, Mayo Clinic, Rochester, Minnesota; and
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Karmali DN, Argento AC, Kirenga B, Batra H, Lee HJ, MacRosty CR, Lerner GR, Siddharthan T, Worodria W, Jackson P. A Longitudinal Study of Multimodal Bronchoscopy Training in Uganda. ATS Sch 2023; 4:152-163. [PMID: 37538081 PMCID: PMC10394594 DOI: 10.34197/ats-scholar.2022-0080oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/22/2022] [Indexed: 08/05/2023] Open
Abstract
Background Flexible bronchoscopy is an essential tool in diagnosing and managing pulmonary diseases. However, there is limited capacity for bronchoscopy in low and middle income countries (LMICs). In 2019, a pilot program for flexible bronchoscopy training was launched for local physicians in Kampala, Uganda. We then conducted a follow up multimodal bronchoscopy course after 2 years. Objective The aim of this study is to assess a longitudinal multimodal bronchoscopy training in an LMIC setting. Methods A multimodal follow up curriculum was developed with pulmonologists from Uganda and the United States. The training was delivered to Ugandan providers who attended previous bronchoscopy training and new participants. The training included a prepared curriculum consisting of lectures, simulations, and deliberate practice-based proctoring. A 12-question multiple-choice exam was administered at the beginning and end of the course, assessing knowledge. Procedural competency was measured using a validated assessment tool called the BSTAT (Bronchoscopic Skills and Tasks Assessment Tool). Results were analyzed to evaluate the retention of knowledge among those who took part in previous training and the efficacy of the follow-up curriculum for participants without previous training. Results Among the participants who attended didactic training in 2022 (11), mean exam scores were improved after training, from 43.9 (standard deviation [SD], 11.3) to 59.8 (SD, 16.1) (mean difference [MD], +15.9; SD, 13.9; P = 0.008), but were lower compared with post didactic scores in 2019: 90.8 (SD, 6.1; MD, -31; P < 0.0001). Participants who completed BSTAT assessments (8) had mean scores similar in 2019 and 2022, at 72.1 and 75.2, respectively (MD, 3.1; P = 0.38). Conclusion This study provides an example of how a longitudinal multimodal bronchoscopy curriculum can improve competency and proficiency for local physicians in an LMIC.
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Affiliation(s)
- Dipan N. Karmali
- Division of Pulmonary and Critical Care, University of Miami Health System, Miami, Florida
| | - A. Christine Argento
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland
| | - Bruce Kirenga
- College of Health Sciences and
- Makerere Lung Institute, Makerere University, Kampala, Uganda
| | - Hitesh Batra
- Division of Pulmonary and Critical Care, University of Alabama Birmingham, Birmingham, Alabama
| | - Hans J. Lee
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland
| | - Christina R. MacRosty
- Division of Pulmonary and Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and
| | - Guil R. Lerner
- Division of Pulmonary and Critical Care, University of Miami Health System, Miami, Florida
| | - Trishul Siddharthan
- Division of Pulmonary and Critical Care, University of Miami Health System, Miami, Florida
| | - William Worodria
- College of Health Sciences and
- Makerere Lung Institute, Makerere University, Kampala, Uganda
| | - Peter Jackson
- Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, Virginia
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Learning Curves in Electromagnetic Navigational Bronchoscopy: What Do They Tell Us? ATS Sch 2022; 3:171-174. [PMID: 35924200 PMCID: PMC9341489 DOI: 10.34197/ats-scholar.2022-0046ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Zarogoulidis P, Hatzibougias D, Tsakiridis K, Hohenforst-Schmidt W, Huang H, Bai C, Kougas N, Vagionas A, Tryfon S, Saroglou M, Freitag L, Kosmidis C, Lallas A, Matthaios D, Sardeli C. Interventional bronchoscopy for HPV 16 and 66 with the use of spraying interferon-α (2b) plus bevacizumab and anti-reflux agent. Respir Med Case Rep 2021; 33:101398. [PMID: 33850702 PMCID: PMC8039836 DOI: 10.1016/j.rmcr.2021.101398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/04/2021] [Accepted: 03/15/2021] [Indexed: 11/25/2022] Open
Abstract
A fifty year old male was diagnosed with bronchial HPV. He was treated with local interventional treatment argon plasma coagulation and subcutaneous injections bevacizumab. Spraying of the regions followed with a specially designed catheter with interferon-α (2b). Systematic treatment of esomeprazole was also administered. After six months the patient is disease free and on close follow-up.
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Affiliation(s)
- Paul Zarogoulidis
- 3rd University General Hospital, "AHEPA" University Hospital, Thessaloniki, Greece.,Pulmonary Department, "Bioclinic" Private Clinic, Thessaloniki, Greece
| | | | - Kosmas Tsakiridis
- Thoracic Surgery Department, "Interbalkan" European Medical Center, Thessaloniki, Greece
| | - Wolfgang Hohenforst-Schmidt
- Sana Clinic Group Franken, Department of Cardiology, Pulmonology, Intensive Care, Nephrology, "Hof" Clinics, University of Erlangen, Hof, Germany
| | - Haidong Huang
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, PR China
| | - Chong Bai
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, PR China
| | - Nikos Kougas
- Rheumatology Department, "Hippokratio" University Hospital, Thessaloniki, Greece
| | | | - Stavros Tryfon
- Pulmonary Department (NHS), "G. Papanikolaou" General Hospital, Thessaloniki, Greece
| | - Maria Saroglou
- Pulmonary Department (NHS), "G. Papanikolaou" General Hospital, Thessaloniki, Greece
| | - Lutz Freitag
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | | | - Aimilios Lallas
- First Dermatology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Chrisanthi Sardeli
- Department of Pharmacology & Clinical Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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