Dabscheck Eli J, Hew Mark, Irving Louis, Steinfort Daniel
*Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Prahran †Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Victoria.
J Bronchology Interv Pulmonol. 2014 Apr;21(2):117-22. doi: 10.1097/LBR.0000000000000048.
The Australasian practice and training in bronchoscopy has not previously been reported and procedure volumes among Australasian respiratory consultants and trainees are unknown. We surveyed the current practice of flexible bronchoscopy in Australasia and determined adherence to published recommendations.
Adult physician and trainee members of the Thoracic Society of Australia New Zealand (TSANZ) were e-mailed a web-link to an online survey. Survey responses were benchmarked against TSANZ recommendations.
The response rate was 42% overall and 78% among trainees. Forty-nine percent of consultants performed less than the recommended 50 procedures per year. Sixty percent of trainees were unlikely to achieve the recommended 200 supervised bronchoscopies during training. Less than 20% of trainees received adequate training in advanced bronchoscopic techniques such as transbronchial lymph node aspiration. The majority of physicians performing such advanced techniques were not performing sufficient numbers to satisfy published recommendations.
A large proportion of Australasian bronchoscopists do not meet "numbers-based" recommendations. This empirical data support the 2012 TSANZ interventional guidelines' call to move beyond procedural volume as the sole determinant of technical competence. There is an urgent need to explore alternative means of developing and defining bronchoscopic proficiency.
此前尚无关于澳大利亚和新西兰支气管镜检查实践与培训的报道，澳大利亚和新西兰呼吸科顾问医生及实习医生的操作量也未知。我们调查了澳大利亚和新西兰目前的可弯曲支气管镜检查实践情况，并确定了对已发表建议的遵守情况。
通过电子邮件向澳大利亚新西兰胸科协会（TSANZ）的成年医生和实习医生成员发送在线调查问卷的网络链接。根据TSANZ的建议对调查回复进行基准评估。
总体回复率为42%，实习医生的回复率为78%。49%的顾问医生每年进行的操作少于建议的50例。60%的实习医生在培训期间不太可能完成建议的200例有监督的支气管镜检查。不到20%的实习医生接受过诸如经支气管淋巴结穿刺等先进支气管镜技术的充分培训。进行此类先进技术操作的大多数医生操作数量不足，无法满足已发表的建议。
很大一部分澳大利亚和新西兰的支气管镜检查医生未达到“基于数量”的建议。这些实证数据支持了TSANZ 2012年介入指南中提出的呼吁，即不应仅将操作量作为技术能力的唯一决定因素。迫切需要探索发展和界定支气管镜检查熟练程度的替代方法。
