Executive Summary of Training and Competence Standards for the Interventional Pulmonology Master Program in Italy

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Interventional pulmonology (IP) is experiencing a rapid evolution of new technologies. As patient safety and outcome-based evaluation of clinical practice and procedures have become priorities, we must consider the need for standardization in procedural training continuing even after the pulmonary and critical care fellowships.1 There is a need to develop structured training programs, organized in high-volume expert centers, to improve trainee education, including the development of validated metrics for their competency assessment.2,3 Concerning teaching methods, a gradual progression from theory to practice, using new teaching techniques, including live sessions and low-fidelity and high-fidelity simulation, flipped classroom models, and problem-based learning exercises, would provide a training setting more suitable for our current need to improve skills and update professionals. Training programs should be learner centered and competence oriented, as well as being based on a spiral-shaped approach in which the same subject is addressed many times, from new and different perspectives of knowledge, ability, behavior, and attitude, until the trainee has demonstrated a high degree of skill and professionalism.2–5
On the basis of the model of ultra-specialty disciplines, such as Interventional Cardiology and Digestive Endoscopy, several international projects are underway to establish structured training and certification programs for IP as well.6,7 In the United States, >30 new postspecialty fellowships in IP have been established since 2005, each one lasting 1 or 2 years. The Association of Interventional Pulmonology Program Directors (AIPPD), in collaboration with the American Association for Bronchology and Interventional Pulmonology (AABIP) and the American College of Chest Physicians (ACCP), have launched a program aimed at standardizing competencies and training on the basis of the recommendations of the Accreditation Council for Graduate Medical Education (ACGME).7,8 In January 2017, a document on Interventional Pulmonology Fellowship Accreditation Standards was published by the Multisociety Interventional Pulmonology Fellowship Accreditation Committee to ensure that all IP fellowship training programs are provided with the minimum resources, expertise, facilities, curriculum, and caseload for adequate training.9 The European Respiratory Society (ERS) also established a program in 2016 offering professional certification of competence in endobronchial ultrasound (EBUS). This 3-part training program ensures that participants possess all the necessary knowledge and skills required to obtain ERS certification in EBUS competence.10
In 2010, we recognized that, in Italy too, there is a gap between the fellowship programs in pulmonology and the real world, and therefore began to organize an academic postspecialty 1-year course (fellowship) on IP, involving leading experts in the field. As the number of procedures required to achieve competence is beyond the capacity of a single center, an integration and cooperation was established among several hospitals allowed to train professional interventional pulmonologists in a structured, standardized, and effective manner. These participating sites have the recognized knowledge base, skill, attitudes, cases, and series of patients. Over the years, we felt the need to standardize our training program to be adopted not only during the Master class but also as a part of lifelong training, so as to gradually achieve full competence in the majority of IP skills. A Consensus Conference on the professional training and competence standards in IP was organized to come to an agreement on a core curriculum. The objective was to describe the professional profile of an interventional pulmonologist and the training process needed to achieve a level of competence that enables participants to perform and manage, both independently and as a team member, all the essential knowledge and procedures in IP.
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