CLINICAL PRACTICE GUIDELINES Advanced interventional pulmonology procedures: Training guidelines from the Thoracic Society of Australia and New Zealand DAVID FIELDING, 1 MARTIN PHILLIPS, 4 PETER ROBINSON, 5 LOUIS IRVING, 6 LUKE GARSKE 2 AND PETER HOPKINS 3 1 Royal Brisbane and Women’s Hospital, 2 Princess Alexandra Hospital, 3 The Prince Charles Hospital, Brisbane, 4 Sir Charles Gairdner Hospital, Perth, 5 Royal Adelaide Hospital, Adelaide, and 6 Royal Melbourne Hospital, Melbourne, Australia ABSTRACT Training in interventional pulmonology procedures is increasing in popularity. However, the nature of train- ing is difficult to define, particularly with respect to an adequate number of cases. These guidelines approach training not just from a modest number of supervised cases, but also from a range of educational and outcome targets which give a rounded approach to the issue. These include prerequisite skills from basic pro- cedures, the place of simulated training, formal simu- lation testing, modest procedural outcome and side effect targets, audit presentations, ongoing reading, and hands-on training expectations. All of this would still be under the supervision of an experienced trainer. Key words: bronchoscopy/standards, computer simulation, education, respiratory tract diseases/ ultrasonography. INTRODUCTION These guidelines for thoracic medicine advanced procedural training encourage fulfilment of a range of parameters, not just accumulating an empirical number of cases. These include the following: 1 Completion of requisite reading and formal teach- ing on evidence relating to disease-specific applica- tions of the methods (e.g. lymph node staging in lung cancer, pleural effusion management in lung cancer) and procedure-specific theory (e.g. laser bronchoscopy, argon plasma coagulation (APC) or diathermy). 2 Completion of simulated training, preferably before commencing procedures in patients. 3 Empirical numbers as a starting point. 4 The importance of a teacher–student relationship. The trainee has to achieve competence in the proce- dure 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. 5 Attainment of modest procedural outcome mea- sures during training and in ongoing clinical practice. 6 Attendance at dedicated procedural conferences and fulfilment of modest presentation and/or publi- cation goals. 7 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. 8 Record keeping on procedural outcomes. The procedures covered in these guidelines are the following: • Endobronchial ultrasound transbronchial needle aspiration (EBUS TBNA) • EBUS guide sheath • Medical thoracoscopy • Rigid bronchoscopy • Thermal techniques • Laser bronchoscopy • Endobronchial electrosurgery • Endobronchial stents • Autofluorescence bronchoscopy (AFB) and narrow band imaging (NBI) Ultimately, a demonstration of adherence to these points should allow a trainee to present their training experience for a particular procedure to a hospital Correspondence: David Fielding, Department of Thoracic Medicine, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia. Email: david_fielding@health.qld.gov.au Received 18 April 2012; invited to revise 7 May 2012; revised 15 May 2012; accepted 24 May 2012 (Associate Editor: David Feller-Kopman). © 2012 The Authors Respirology © 2012 Asian Pacific Society of Respirology Respirology (2012) 17, 1176–1189 doi: 10.1111/j.1440-1843.2012.02253.x