In recent years, there has been a rapid growth in diagnostic and therapeutic procedures performed by respirologists.
To assess the number and type of procedures performed in Canadian respirology training programs, for comparison with the American College of Chest Physicians minimum competency guidelines, and to assess fellow satisfaction with procedural training during their fellowships.
Internet-based surveys of Canadian respirology fellows and respirology fellowship program directors were conducted.
Response rates for program director and respirology fellow surveys were 71% (10 of 14) and 62% (41 of 66), respectively. Thirty-eight per cent of respirology fellows reported the presence of an interventional pulmonologist at their institution. Flexible bronchoscopy was the only procedure reported by a large majority of respirology fellows (79.5%) to meet American College of Chest Physicians recommendations (100 procedures). As reported by respirology fellows, recommended numbers of procedures were met by 59.5% of fellows for tube thoracostomy, 21% for transbronchial needle aspiration and 5.4% for closed pleural biopsy. Respirology fellows in programs with an interventional pulmonologist were more likely to have completed some form of additional interventional bronchoscopy training (80% versus 32%; P=0.003), had increased exposure to and expressed improved satisfaction with training in advanced diagnostic and therapeutic procedures, but did not increase their likelihood of achieving recommended numbers for any procedures.
Canadian respirology fellows perform lower numbers of basic respiratory procedures, other than flexible bronchoscopy, than that suggested by the American College of Chest Physicians guidelines. Exposure and training in advanced diagnostic and therapeutic procedures is minimal. A concerted effort to improve procedural training is required to improve these results.
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By analyzing their own experience in training foreign students, the authors concluded that University education in phthisiology may be improved by increasing a role of independent work by using the special text-book prepared by the Department of Tuberculosis, Kursk State Medical University.
The current approaches to training pediatric phthisiatricians (phthisiopediatricians) are described. In the authors' opinion, completion of a clinical residency in not only phthisiology, but also in pediatrics is optimal to this group of specialists. The training programs for pediatric phthisiatricians differ in relation to the basic specialty: a phthisiatrician or a local phthisiatrician. Topical improvement may be made more frequently, it aims at upgrading qualification in more specialized section on phthisiology, and it is intended not only for pediatric phthisiatricians, but also for pediatricians of children's health care facilities. Training cycles in Moscow upgrades the quality of antituberculous work at the children's facilities. Difficulties in organizing the retraining of physicians of other specialties in phthisiology need normative resolution.
The quality of the diagnosis and treatment of lung diseases was assessed in the polyclinics of the Northern Administrative District of Moscow by 2 methods: (1) selective examination of 960 case histories of bronchial asthma and chronic obstructive pulmonary diseases and (2) questionnaire survey and spirometry of 2132 patients aged 35 to 75 years who have visited a polyclinic for no respiratory diseases. Random check of the case histories revealed a large number of diagnostic and medical errors suggesting the undertraining of therapists in pulmonology. The performed cycles of educational programs could considerably reduce the number of the errors found on recheck. Questionnaire survey and spirometry could increase the number of diagnosed cases of chronic lung diseases by 10 times.