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Graduating Fellows’ Procedural Comfort Level With Pulmonary Critical Care Procedures

Knox, Daniel B. MD; Wong, William W. DO

Journal of Bronchology & Interventional Pulmonology: October 2019 - Volume 26 - Issue 4 - p 231–236
doi: 10.1097/LBR.0000000000000563
Original Investigations

Background: Graduating fellows from pulmonary and critical care programs are expected to independently perform bronchoscopy and common medical procedures in the intensive care unit. Given variable exposure and learning opportunities at different training programs, little is known about how comfortable graduating fellows are with these procedures.

Methods: A survey concerning the ACGME required procedures for pulmonary and critical care fellowship was sent to graduating fellows and program directors at all ACGME accredited subspecialty fellowship programs in pulmonary, critical care, and combined pulmonary critical care medicine.

Results: Critical care fellows performed the most intubations, paracenteses, arterial lines, central venous catheter insertions, and cardioversions, but did not perform as many bronchoscopy related procedures as the other subgroups. Pulmonary and combined pulmonary/critical care fellows performed and felt confident in most procedures. Program directors from all specialties agreed with the fellows overall about the procedural confidence gained during training. There also appeared to be a correlation between number of procedures performed and the confidence of the proceduralist. There appears to be a certain threshold number of successful completions to achieve confidence for independent practice for each surveyed procedure.

Conclusion: There is a correlation between a fellow’s procedural comfort with independent practice and the number of successful attempts by a graduating fellow. There are no universal guidelines that outline the appropriate number of successful attempts needed for independent practice, and our data strongly suggests that there is a threshold for each procedure across these three subspecialties.

Division of Pulmonary, Allergy & Critical Care, University of Massachusetts Medical School, Worcester, MA

D.B.K.: had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis, including and especially any adverse effects; also contributed substantially to the study design, data analysis and interpretation, and the writing of the manuscript. W.W.W.: contributed substantially to the data analysis and interpretation, and the writing of the manuscript.

Disclosure: There is no conflict of interest or other disclosures. There was funding for the survey response prizes awarded by the University of Massachusetts Medical Center Division of Pulmonary, Allergy and Critical Care Medicine.

Reprints: Daniel B. Knox, MD, University of Massachusetts Medical School, Division of Pulmonary Allergy & Critical Care Medicine, 55 Lake Avenue North, Worcester, MA 01655 (e-mail:

Received June 18, 2018

Accepted November 12, 2018

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