Training in Laser Bronchoscopy and Proposals for Credentialling (Part 3)

There were several problems in trying to conduct such training. First, practicing pulmonary physicians tend to be a busy lot, and the demands of other patient care issues often made it difficult to come to the teaching hospital on a regularly scheduled basis, even when the teaching institution was located in the same metropolitan area. Second, patients who required bronchoscopy at the teaching institution would be identified in variable numbers for a given day, which made it difficult for the practicing physician to know when adequate caseloads would justify time away from the practice to acquire the desired training and experience. Third, fellows in the training program at the teaching institution greeted such “outsiders” with less than a warm welcome for performing the bronchoscopies under the tutelage of the faculty, as such arrangements would necessarily reduce their caseloads for similar training and experience. There were two other problems with such arrangements. In some institutions (and this is even more of a problem today), the medical bylaws and concerns regarding liability issues are such that an arrangement of this sort would not allow the preceptor any “hands-on” experience. The trainee could only function as an observer. By training in a nonformal way such as this, there is always the potential that the trainee may not become sufficiently adept at the procedure so as to assure optimal performance and application in practice, and the review mechanisms to correct any such deficiencies are much less effective than is possible in a structured residency training program. buy prednisone