Training in Laser Bronchoscopy and Proposals for Credentialling: Problems Encountered During and ArrER Laser Bronchoscopy Courses (Part 2)

Upon returning to the home practice after attending a laser bronchoscopy course, few physicians have access to animal laboratories to continue practice on such models before beginning to perform laser bronchoscopy in humans. Regardless of whether additional experience with a canine model can be acquired, it is difficult within a local community practice to convince ones colleagues (such as a thoracic surgeon or otorhi-nolaryngologist) to teach and supervise the training of a flexible bronchoscopist with the necessary caseload to become proficient in rigid bronchoscopy.
Pulmonary physicians, therefore, usually must choose between not applying what they have learned at such a course or performing laser bronchoscopy only through flexible bronchoscopes. To learn what actually happened as laser bronchoscopy course attendees returned to their home practices for this and other issues, I decided to survey physicians who attended courses we conducted.
Questionnaires were mailed to 127 course attendees approximately one year after the last one was conducted (October 1986), which was an average of 24.5 months after completing the laser bronchoscopy courses. Responses were received from 67 (55 percent). The results of that questionnaire survey are displayed in Tables 1 to 3. buy prednisone

Table I—Equipment Available and Experience of Course Attendees (n = 67)

At Time Course Was Held

At Time Survey Conducted

Yes

No

Yes

No

Hospital possesses

28 (42%)

39 (58%)

48 (73%)

19 (27%)

YAG laser

Current laser

11 (16%)

56 (84%)

30 (45%)

37 (55%)

bronchoscopy

experience of course

attendee


Table 2—Technical Aspects of Laser Bronchoscopy Chosen by Course Attendees Who Were Performing Laser Bronchoscopy Upon Beturn to Their Home Practices (n = 30)

Type of bronchoscope used

Flexible

9 (30%)

Rigid

8 (27%)

Both

12 (40%)

Type of anesthesia

Local

4 (13%)

General

26 (87%)

Location where laser bronchoscopy performed

Special Procedures

7 (23%)

Operating Room

22 (73%)

Table 3—Experience with Laser Bronchoscopy of Course Attendees After Course Attendance (n = 30)

Number of laser bronchoscopies performed

1-5 Cases

12

(40%)

6-25 Cases

12

(40%)

>25 Cases Location of lesions treated*

6

(20%)

Trachea or main stem bronchi

522

(82.5%)

Lobar bronchi

102

(16.1%)

Segmental bronchi

9

(1.4%)

Complications encountered* Postop infections from necrosis

10

Massive bleeding

4

Pneumothorax

2

Arrhythmia

2

Respiratory failure

1

Fire (minor)

1

Metal tip lost

1

Mediastinitis

1

Total

22

(3.8%)

Fatalities*

4

(0.6%)

*n = 633 cases.

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