CHEST Original Research PULMONARY PROCEDURES journal.publications.chestnet.org CHEST / 144 / 3 / SEPTEMBER 2013 935 I nterventional pulmonology (IP) is an emerging sub- specialty field. Growth over the past decade has been spurred by technological advances and the increasing number of sophisticated procedures. In recent years, dedicated 12-month IP training programs have become more prevalent across the United States and Canada. In 2007, there were five dedicated IP fellowship pro- grams listed with the American Association of Bron- chology and Interventional Pulmonology. Over the past 5 years, this number has more than tripled to 18 listed IP fellowship training programs, and IP joined the National Residency Match Program in 2010. 1 The need for formalized training in IP was partially driven by the limited training in the management of complex airway and pleural disease during traditional pulmo- nary training. 2 Initial efforts to standardize IP training have included the development of an IP fellowship training curriculum, joining the National Residency Match Program, program-wide fellowship in-service examinations, and the development of the Association of Interventional Pulmonary Program Directors. 2-5 Despite this early progress, determining the thresh- old for procedural competency remains ambiguous and is largely based on expert opinion. 6,7 Also, as new Background: Current interventional pulmonary (IP) procedural guidelines for competency are based on expert opinion. There are few objective data to support competency metrics for IP pro- cedures. This survey reports procedural volume during IP fellowships to help define new stan- dards in training and curriculum development. Methods: A web-based survey was developed to evaluate IP training procedural volume. The sur- vey was administered to all US and Canadian IP fellowship directors and graduates in training from 2006 to 2011. The survey inquired about all diagnostic and therapeutic procedures per- formed during the specialized year of IP training. Questions regarding the training program structure were collected and analyzed. Results: There was a 92.5% fellow response rate (37 of 40) and 77% fellowship director response rate (10 of 13) from programs in existence at the time of the survey. Procedural volume was con- sistent between fellowship directors and graduates ( P 5 .64). Although there was a wide range of procedural volume and types of procedures between different programs, the procedural mean volumes were all significantly higher than the American College of Chest Physicians (ACCP) and American Thoracic Society/European Respiratory Society (ATS/ERS) guideline recommendations ( P , .005). Conclusions: US and Canadian IP fellowships produce fellows with variable procedural volumes; however, these are significantly higher than ACCP and ATS/ERS guidelines for most programs and procedures. With a uniform training curriculum being adopted by the majority of IP fellow- ship programs in the United States and Canada, as well as data showing improved core knowl- edge in IP fellows undergoing a dedicated year of additional training, further metrics examining the impact of advanced IP training on patient outcomes are needed. CHEST 2013; 144(3):935–939 Abbreviations: ACCP 5 American College of Chest Physicians; ACGME 5 Accreditation Council for Graduate Med- ical Education; ATS/ERS 5 American Thoracic Society/European Respiratory Society; IP 5 interventional pulmonology; PEG 5 percutaneous endoscopic gastrostomy Procedural Volume and Structure of Interventional Pulmonary Fellowships A Survey of Fellows and Fellowship Program Directors Lonny Yarmus, DO, FCCP; David Feller-Kopman, MD, FCCP; Melhem Imad, MD; Stephanie Kim, BS; and Hans J. Lee, MD, FCCP Downloaded From: http://journal.publications.chestnet.org/ on 08/12/2016