Fielding D, Phillips M, Robinson P, Irving L, Garske L, Hopskin P.
These guidelines for Thoracic Medicine advanced procedural training encourage fulfilment of a range of parameters, not just accumulating an empiric number of cases.
These include:
Empiric numbers as a starting point
The importance of a teacher-student relationship. The trainee has to achieve competence in the procedure as certified by an accredited trainer. As a guide it usually takes about 20 cases to have achieved the appropriate skill level, however that can vary as judged by the expert trainer
Attainment of modest procedural outcome measures during training and in ongoing clinical practice
Attendance at dedicated procedural conferences and fulfilment of modest presentation and/or publication goals
Completion of simulated training, preferably before commencing procedures in patients
Ultimately, when it becomes available, a “pass” on a universally accepted objective assessment tool. In the absence of this last parameter, we can at least insist that trainees undertake simulated training, and that such training itself has an objective assessment. In time such an assessment could become either a goal prior to commencing patient practice OR, when such tools are more fully developed, a means of evaluating the individual’s overall technical skill in the procedure
Record keeping on procedural outcomes.
The procedures covered in these guidelines are:
EBUS TBNA
EBUS Guide sheath
Medical Thoracoscopy
Rigid bronchoscopy
Laser bronchoscopy
Endobronchial stents
Endobronchial electrosurgery
Autofluorescence bronchoscopy
Ultimately a demonstration of adherence to these points should allow a trainee to present their training experience for a particular procedure to a hospital credentialing committee to allow commencement of practice.