Schramm Dirk
Division of Pediatric Pulmonology, University Childrens Hospital, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
Pediatr Pulmonol. 2025 Mar;60 Suppl 1(Suppl 1):S8-S10. doi: 10.1002/ppul.27256. Epub 2024 Sep 16.
To review the evolution of pediatric pulmonology interventions and propose strategies for advancing training in the field.
I examined the historical development of pediatric pulmonology interventions and current training practices, including hands-on courses and fellowship programs. I reviewed a survey of US pediatric pulmonology centers to assess variability in procedural expertise.
Historically, foreign body removal dominated pediatric pulmonology interventions. Advancements in technology have expanded the field to include techniques such as endobronchial and transbronchial biopsies, airway lumen restoration, and cryotherapy, enabling more accurate tissue sampling with larger specimens while maintaining safety. Hands-on courses, offered globally and at major conferences, provide opportunities for skill development, self-assessment, and networking. However, limited availability leads to high demand and long waiting lists. A survey of US pediatric pulmonology centers revealed significant variability in procedural expertise, highlighting the need for uniform training across institutions.
To better integrate interventional techniques, I propose that pediatric pulmonology training could benefit from a structured, tiered approach: (1) expanding hands-on workshops and incorporating them into fellowship programs, (2) facilitating collaborations between centers of excellence to allow trainees to rotate through institutions with advanced expertise, and (3) developing an additional year of training for an "Advanced Pediatric Pulmonologist" certification. This approach aims to ensure proficiency in the latest interventional techniques, standardize care, and foster advancements across the field.
回顾儿科肺病学干预措施的发展历程,并提出推动该领域培训的策略。
我研究了儿科肺病学干预措施的历史发展以及当前的培训实践,包括实践课程和进修项目。我回顾了一项对美国儿科肺病学中心的调查,以评估操作技能的差异。
从历史上看,异物取出术在儿科肺病学干预措施中占主导地位。技术进步使该领域得以扩展,纳入了诸如支气管内活检和经支气管活检、气道腔修复以及冷冻疗法等技术,在保持安全性的同时,能够获取更大标本进行更准确的组织采样。在全球范围内和主要会议上提供的实践课程,为技能发展、自我评估和建立人脉提供了机会。然而,课程供应有限导致需求旺盛,等候名单很长。一项对美国儿科肺病学中心的调查显示,操作技能存在显著差异,凸显了各机构统一培训的必要性。
为了更好地整合介入技术,我提议儿科肺病学培训可受益于一种结构化的分层方法:(1)扩大实践工作坊并将其纳入进修项目;(2)促进卓越中心之间的合作,使学员能够在拥有先进专业知识的机构间轮转;(3)增设一年培训以获得“高级儿科肺病专家”认证。这种方法旨在确保掌握最新的介入技术,规范医疗护理,并推动该领域的发展。