Training in Laser Bronchoscopy and Proposals for Credentialling (Part 5)

Moreover, I would suggest that the complexity of the procedure is considerably greater for laser bronchoscopy than it is for diagnostic or other therapeutic bronchoscopy, so the skills tend to take longer to learn and give rise for greater potential misadventures. What avenues are open to assure the best possible training for all who want or need to acquire this training, and at the same time provide patients with the most competent care we as a profession can deliver? There is the temptation to try to devise a minimum set of initial training recommendations and credentialling requirements to perform these procedures. As a profession, I think we owe ourselves and our patients more than to set minimum standards. A similar approach was ultimately chosen by the Inter-Society Commission for Heart Disease Resources as it published recommendations for cardiac surgery programs. The same Commission published optimal resource guidelines for radiologic facilities for conventional x-ray examination of the heart and lungs, catheterization-angiographic laboratories, cardiovascular surgical operating rooms and intensive care units, ultrasonic examination of the heart, and implantable cardiac pacemakers. Whereas many of these procedures and methods of delivering care are far more complex than laser bronchoscopy, some of them are similar in magnitude and scope. Before proposing guidelines for credentialling in laser bronchoscopy, it is appropriate to consider training methods.