Training In Respiratory Medicine Research Articles

Comparing performance of primary care clinicians in the interpretation of SPIROmetry with or without Artificial Intelligence Decision support software (SPIRO-AID): a protocol for a randomised controlled trial

IntroductionSpirometry is a point-of-care lung function test that helps support the diagnosis and monitoring of chronic lung disease. The quality and interpretation accuracy of spirometry is variable in primary care....

Assessment methods in respiratory medicine training in Europe: current status and future needs.

There is a perceived need for harmonisation of training standards in medicine across Europe. Assessment methodology is a fundamental part of this harmonisation. Assessment may be: summative, measuring competency at the end of training, usually in a pass/fail mode; or formative, assessing strengths and weaknesses during training with a view to optimising performance. A survey of experienced respiratory medicine trainers in Europe was undertaken to discover the formative and summative assessment methods being used, and to explore the use of workplace-based assessments (WBAs). Structured interviews were sought with experienced trainers in adult and paediatric respiratory medicine. 35 trainers from 22 (71%) out of 31 countries were interviewed.The number of types of summative assessments required at the end of training varied from 0 to 4 including clinical (25%), written (44%) and oral (47%) examinations. Four respondents required a research thesis as a proof of clinical competence.WBA was not commonly used. Only 14% of respondents reported using a formal case-based discussion, 20% used a form of multisource feedback and 25% described some form of formal assessment of procedural skills. However, 77% of all respondents expressed a wish to have access to case-based discussion and 72% wanted to have a facility for multisource feedback. The majority also wanted training in the use of these tools. Almost half of the respondents had received no formal training in educational supervision and 80% of all respondents expressed a wish to receive such training.The findings suggest that there is no adequate process of ensuring uniform standards for specialist accreditation in Europe, and demonstrate a need and desire among trainers for more WBA tools and training in their use to be made available.

What does the future hold for the Lung Cancer Ambition Alliance project: an interview with Giorgio Scagliotti.

Bio Dr Scagliotti is currently Professor of Oncology at the University of Torino, Italy. Dr Scagliotti earned his medical degree and completed the postgraduate training in respiratory medicine, internal medicine and medical oncology at the University of Torino. He is currently chief of the Medical Oncology Division at the S. Luigi Hospital, Orbassano (Torino), former Head of the Department of Oncology at University of Torino. Dr. Scagliotti is a member of several scientific societies, including the Italian Society of Respiratory Medicine, the European Respiratory Society, the American Society of Clinical Oncology and the International Association for the Study of Lung Cancer (IASLC). From 2003-07 Executive Board Member of the IASLC. He has been Associate Editor for Journal of Thoracic Oncology and currently International Editor for Clinical Lung Cancer. He is the author or co-author of more than 360 publications in peer-reviewed journals and he is the International Editor of the 4th Edition of "Lung Cancer : Principles and practice" and co-editor of the IASLC textbook of multidisciplinary approach to thoracic Oncology.

Editorial introductions

Editorial introductions

Respiratory medicine training inMalta.

In Malta, respiratory medicine is quite a popular speciality. It is attractive because of the interesting case mix and the interventional element of the speciality.

Interview: developing therapies for lung cancer.

Silvia Novello speaks to Roshaine Wijayatunga, Managing Commissioning Editor: Silvia Novello is a Full Professor of Medical Oncology in the Oncology Department at San Luigi Hospital in Orbassano, Italy, part of the University of Turin. She earned her medical degree and completed the postgraduate training in respiratory medicine and medical oncology at the University of Turin and partially at the Institut Gustave Roussy in France. Currently, she is head of the Thoracic Oncology Unit at the San Luigi Hospital, Orbassano (Turin), where she also tutors medical students and postgraduate students in respiratory medicine and medical oncology. Novello's research interests include thoracic malignancies, primary prevention, gender differences in lung cancer, basic and clinical applied research on lung cancer, including pharmacogenomics. She is involved in many European and national controlled clinical trials evaluating new approaches in diagnosis and lung cancer therapy. From July 2012 until 2016, Novello has been a Member of the Board of Directors of the International Association for the Study of Lung Cancer and since October 2016 Member of the Board of Directors of the Italian Association of Medical Oncology and member of other several scientific societies including the American Society of Clinical Oncology and the European Society of Medical Oncology. Currently, she is the President of Women Against Lung Cancer in Europe, a nonprofit European Association founded in 2006 in Turin, Italy, part of the scientific Committee of Lung cancer Europe and also a member of the Scientific Committee of Bonnie J Addario Lung Cancer Foundation and Member of the Scientific Committee of Investigación sobre Cáncer de Pulmón en Mujeres. She is the author or co-author of over 100 publications in peer-reviewed journals.

My night on call in Poland.

I am a young doctor who graduated from the Medical University of Silesia in 2014. After 13 months of postgraduate training, passing a state examination and successful completion of the admission process I made a decision to specialise in Respiratory Medicine. I started working in a large clinical hospital that provides junior doctors with excellent opportunities for training and career development. The respiratory unit is highly specialised and deals with sleep-related medical problems, interstitial lung diseases and respiratory failure, which may be treated using noninvasive mechanical ventilation. Along with my training in respiratory medicine I decided to start working as an emergency room doctor in a different hospital, in order to improve my skills in treating life-threatening conditions.

Respiratory training in Scotland.

Specialty training in respiratory medicine in the UK takes a period of at least 4 years, but the majority of trainees will spend 5 years attaining certification to practice both respiratory and general internal medicine. In order to enter a training programme, candidates will have typically been working for at least 4 years and must show they have achieved the desired competencies in foundation and core general medicine training. They must also have passed the Membership of the Royal College of Physicians postgraduate exams. The recruitment process occurs once a year and is performed nationally. Respiratory medicine is regarded as a competitive specialty. Over the course of 5 years, trainees will be attached to a deanery that represents a geographical area and they will rotate through hospitals in this area to experience both respiratory and general medicine in a variety of environments, i.e. large teaching hospitals and smaller district general hospitals. There are four Scottish deaneries, each based around a city with associated teaching hospitals: South-east (Edinburgh), West (Glasgow), East (Dundee) and North (Aberdeen). Respiratory medicine has close links with acute medicine and general internal medicine as a large proportion of acute admissions (30%) have a primary respiratory pathology [1], and in many hospitals respiratory physicians will have a role in working in acute medical receiving units. Due to the high prevalence of respiratory disease, on-call shifts tend to be busy, with requests to review patients on other inpatient wards …

Gaps in capacity for respiratory care in developing countries. Nigeria as a case study.

There are unmet needs for respiratory medical care in developing countries. We sought to evaluate the quality and capacity for respiratory care in low- and lower-middle-income countries, using Nigeria as a case study. We obtained details of the respiratory practice of consultants and senior residents (fellows) in respiratory medicine in Nigeria via a semistructured questionnaire administered to physician attendees at the 2013 National Congress of the Nigerian Thoracic Society. Out of 76 society-registered members, 48 attended the congress, 40 completed the questionnaire, and 35 provided complete data (73% adjusted response rate). Respondents provided information on the process and costs of respiratory medicine training and facility, equipment, and supply capacities at the institutions they represented. Approximately 83% reported working at a tertiary level (teaching) hospital; 91% reported capacity for sputum smear analysis for acid alcohol-fast bacilli, 37% for GeneXpert test cartridges, and 20% for BACTEC liquid sputum culture. Only 34% of respondents could perform full spirometry on patients, and none had the capacity for performing a methacholine challenge test or for measuring the diffusion capacity for carbon monoxide. We estimated the proportion of registered respiratory physicians to the national population at 1 per 2.3 million individuals. Thirteen states with an estimated combined population of 57.7 million offer no specialist respiratory services. Barriers to development of this capacity include the high cost of training. We conclude that substantial gaps exist in the capacity and quality of respiratory care in Nigeria, a pattern that probably mirrors most of sub-Saharan Africa and other countries of similar economic status. Health policy makers should address these gaps systematically.

Diana Bilton: a pioneer in cystic fibrosis

Diana Bilton: a pioneer in cystic fibrosis

Dion Jonathan Maberly

Born in London, Dion Jonathan Maberly was educated at Sutton Vallence School, Kent. After training at St Thomas’ Hospital, London, he spent a year in Washington, DC, as a medical...

Respiratory critical care HERMES syllabus: defining competencies for respiratory doctors

“Coming together is a beginning, staying together is progress and working together is success.” Henry Ford (1863–1947). From a medical perspective, European countries are growing closer together. An increasing number of physicians are crossing borders and swapping workplaces. In order to facilitate this development, the European Union (EU) adopted a directive dictating the equality of diplomas and medical board certificates within the EU [1]. Despite a number of initiatives, such as the “Lifelong Learning Programme: education and training opportunities”, for which the ERASMUS (European Region Action Scheme for the Mobility of University Students) is a sub-programme aimed at harmonising medical education during the early phases of medical training [2], there is a need to standardise knowledge and skills at later career stages in order to guarantee and harmonise the quality of patient care in Europe. To address this, the HERMES project (Harmonised Education in Respiratory Medicine for European Specialists) was launched by the European Respiratory Society (ERS) in 2005 in order to harmonise education and training in respiratory medicine. With the success of this project, the ERS extended its scope to include a Paediatric Respiratory Medicine HERMES and subspecialty-focused HERMES projects. Thus, the Respiratory Critical Care HERMES project was launched in 2009. The project aims to provide educational standards and a training framework for respiratory critical care medicine using standardised modified Delphi surveys, facilitated group discussions and plenary sessions. This is consistent with the ERS mission and has the ultimate goal of providing better patient care. Similar projects in critical care have been launched in the past, such as the multi-society task force on competencies in pulmonary and critical care medicine reported by Buckley et al. [3] in 2009 and the development of core competencies for an international training programme in intensive care …

Editorial

The ability to identify and discharge the low-risk patient, and to predict those cases where deterioration is likely is already a key element of the practice of acute medicine . This is an area which has been extensively examined in the past, but two articles in this edition add an interesting dimension to the literature. The use of physiological variables to calculate risk enables fluctuations in a patient’s condition over time can be monitored, allowing appropriate escalation measures to be instituted. The National Early Warning Score has already been implemented in Wales and roll-out across England is expected imminently. Austen and colleagues have highlighted some of the advantages that a standardised system will provide in comparison to their locally-developed Early Warning Score; however the problem of under-scoring due to incomplete or inaccurate recording remains and will continue until electronic solutions are more widespread. Scoring systems utilising laboratory data from admission are less useful for ongoing monitoring but could provide clinicians with an objective measure of risk at the time of initial assessment. As austerity measures bite, the pressure to direct our limited resources to the most appropriate cases will undoubtedly intensify, making this increasingly important. The rigorous quality control mechanisms in laboratories ensure the reliability of biochemical test results; furthermore most hospitals have electronic systems for recording and displaying results which limits the risk of errors from human transcription. O’Sullivan et al have utilised the extensive database from St James’ hospital in Dublin to develop a score based on a number of biochemical and haematological tests. Although this will need to be prospectively validated, retrospective analysis using a huge sample over a number of years, suggests their score may be highly predictive of good and poor outcome. This has great potential to support clinical decision making at the ‘front door’ and improve utilisation of resources. If variety is the ‘spice of life’, then Acute Medicine is certainly the ‘vindaloo’ of the modern hospital. The enormous breadth of clinical problems encountered on the AMU is apparent from the data gathered in York Hospital during the 15 months prior to April 2011. Variety is a key attraction for many junior doctors considering their career choice, at a time when many areas of hospital practice are becoming increasingly specialised. The acute medicine curriculum has ensured that trainees undertake blocks of training in respiratory medicine and cardiology, which is clearly important given that these areas reflected almost 50% of patients. However the authors highlight that the infrequency of certain problems, such as cord compression and diabetic ketoacidosis might also need to be addressed with training outside the AMU in neurology and endocrinology to ensure adequate exposure to these conditions. The rise in alcohol-related admissions is also highlighted in this article, and our trainee section includes a problem based review of the management of these problems. The obesity epidemic, as well as the proliferation of weight-loss surgery and its complications is another area which increasingly challenges our AMU resources. The article by Fiona Maggs provides some practical advice on how to address these issues. I hope you enjoy this edition, and the summer months ahead...

HERMES criteria for accreditation of European Training Centres: overcoming challenges of accreditation

Accreditation has been defined as a process whereby a professional association or nongovernmental agency grants recognition to a school or healthcare institution for demonstrated ability to meet predetermined criteria for established standards 1 Accreditation within the medical arena is longstanding throughout history. In 1910, the Joint Commission was established with the primary mission of continuously improving healthcare for the public by evaluating healthcare organisations and inspiring them to excel in providing safe and effective treatment of the highest quality and value. In the past 100 years, accreditation has extended to medical education and more specifically the implementation of standards in the training of medical specialists. This article focuses on the accreditation of training centres in adult respiratory medicine. The foundation of the EU directive 75/362/ECC in 1975 produced guidelines for medical training institutions across Europe which was believed would open access to the job market for European specialists in respiratory medicine while also producing documentation for training institutions to follow in order to achieve high-quality education. The implementation of such standards has by no means mirrored the reality of medical training of respiratory specialists in Europe today. Stark differences exist in the training duration, the sitting of exit examinations and accreditation of training centres 2. Consequently, despite such regulations, mobility across Europe continues to be a challenge for some doctors. Considering the unsystematic process of respiratory medicine training across Europe, there is most certainly scope to improve quality in patient care and to fortify adult respiratory medicine. HERMES (Harmonising education in respiratory medicine for European specialists), is an initiative which responded to Europe's need to regulate education in respiratory medicine and ensure raising quality in adult respiratory care. A specialist Task Force representing 13 countries in Europe has worked prolifically since 2005 to support this educational mission for reform. …

HERMES: a European Core Syllabus in Respiratory Medicine

<h3>Summary</h3> HERMES is a project to promote better “Harmonised education and training in Respiratory Medicine for European Specialists”. The first aim of the project was to develop a European core syllabus listing core competencies that all respiratory specialists should possess. This report presents the resulting consensus-based document. A total of 50 experts in respiratory medicine from 29 countries took part in its development. Moreover, over 400 qualified respiratory physicians and over 100 trainees provided further feedback throughout the project. Competencies were identified and ranked through a three-round Delphi consensus process. Some 229 competencies were selected and split into nine sections and 51 modules. Of these, 14 were ranked as optional, 215 as mandatory. Items were further ranked into three different levels, according to the level of knowledge and competence expected. The Delphi process proved an effective tool for creating expert consensus and to enable “group” ownership of the project outcomes.

HERMES: good reasons for harmonising education and training in respiratory medicine

HERMES (Harmonised Education in Respiratory Medicine for European Specialists) was launched in 2005 by the European Respiratory Society (ERS), with the aim of harmonising education and training in respiratory medicine. The first deliverable component, a core syllabus representing the content of required knowledge in our specialty 1, will be released at the 2006 ERS Annual Congress in Munich. It is hoped that this document will be used at the national level for the development of training programmes for both trainees and young respiratory specialists, as a first step towards harmonisation in Europe. Medicine was one of the first professions regulated at the European Union (EU) level. Rules for mutual recognition of diplomas were first set in 1975 in directive 75/362/EEC. This directive concerned the mutual recognition of diplomas, certificates and other evidence of formal qualifications in medicine. Since then, it has been amended several times and lately replaced by a new directive 2005/36/EC, which sets the rules for a whole range of regulated professions. This directive guarantees automatic recognition of diplomas and certificates in all EU countries, thus granting free access to the European job market to all European specialists in respiratory medicine. Regarding respiratory medicine, in 1994, a working group of the European Union of Medical Specialists (UEMS) Pneumology section issued a document that was the basis for the UEMS charter on training 2, 3. It recommended the following structure …

Invited Review Series

The Invited Review Series ‘Tobacco and Lung Health’ continues in this issue with two articles: ‘Women and tobacco’ by Judith Mackay and Amanda Amos and ‘Respiratory health effects of exposure to environmental tobacco smoke’ by Moira Chan-Yeung and Helen Dimich-Ward. Dr Mackay is a medical doctor and Senior Policy Advisor to the World Health Organization. She is based in Hong Kong where she is the Director of the Asian Consultancy on Tobacco Control. She has published widely, and has received many international awards for her work as a health advocate and campaigner for tobacco control. Dr Mackay regards it as a great compliment to have been singled out by the tobacco industry as a person of interest. Her co-author on the paper ‘Women and Tobacco’ is Dr Amanda Amos, a Senior Lecturer in Health Promotion at the University of Edinburgh. Dr Amos’ research has focussed on a range of smoking issues including the influence of the media on smoking, smoking and socio-economic disadvantage, as well as smoking uptake and cessation in the mid-teens. She is an advisor on smoking issues to health departments and health promotion agencies in the UK. The principal research interests of Professor Moira Chan-Yeung, Professor of Medicine at the University of British Columbia, Canada, centre on occupational lung disease as well as environmental and genetic risk factors for asthma and lung cancer. She has also undertaken considerable work on the primary prevention of asthma. She has published over 250 peer-reviewed articles and 50 book chapters as well as co-editing two books. Her co-author, Helen Dimich-Ward PhD, is an associate professor in the Department of Medicine at the University of British Columbia where she works as a BC Lung Association/Canadian Institutes of Health Research Investigator. Her area of expertise is the epidemiology of occupational and environmental respiratory health. Her major research focus is women's occupational health including studies of health care and hospitality workers. The Series ‘Cells of the Lung’ resumes with Dr John Upham's contribution, ‘The role of dendritic cells in immune regulation and allergic airway inflammation’. Dr Upham graduated with honours from the University of Queensland then completed training in respiratory medicine in Brisbane, before moving to Perth to do a PhD on regulation of T-cell activation in the lung. After a period of postdoctoral studies at McMaster University, Canada, he returned to Perth in 1998. His major research interest is the role of dendritic cells in the initiation and maintenance of allergic airway inflammation, an interest that he combines with clinical practice in respiratory medicine. He was recently awarded a 5-year clinical research fellowship by the National Health & Medical Research Council of Australia, and is the author of over 30 publications.