Wednesday, July 1, 2015

Lung Transplant Curriculum in Pulmonary/Critical Care Fellowship Training

Don Hayes, MD, MEd
Nationwide Children's Hospital

Purpose: Although an educational experience in lung transplantation is not required for graduate medical education in Pulmonary/Critical Care (Pulm/CC), a structured lung transplant curriculum was developed for a training fellowship program in order to educate fellows about this expanding area of Pulmonology.

Methods: The curriculum included participation in clinical management of lung transplant candidates and recipients, assigned readings, and lectures on lung transplantation. The educational objectives were referral criteria for lung transplant, selection of lung transplant candidates, management of advanced lung disease, intensive care management after lung transplant, immunosuppressant therapy, and long-term care of lung transplant recipients. To evaluate the impact of the curriculum, scores on in-training examinations (ITE) by Pulm/CC fellows were reviewed 2 years prior to and 3 years after implementation of the curriculum. Data on the number of transbronchial biopsies performed by fellows on clinical rotations was collected, and fellows completed a satisfaction survey that addressed their perceptions of the lung transplantation curriculum and the revised clinical rotation on the advanced lung disease and lung transplant service.
Results: The ITE results of 9 first- and second-year Pulm/CC fellows who completed the curriculum were compared to 6 first- and second-year fellows in the program prior to implementation of the curriculum. The mean ITE score for first-year fellows increased from 54.2 ± 2.5 to 63.6 ± 1.2 (score ± SEM); p = 0.002, while mean ITE score for second-year fellows increased from 63.0 ± 3.0 to 70.7 ± 1.2; p = 0.019. The combined mean ITE score increased from 58.6 ± 2.3 to 67.1 ± 1.2; p = 0.001. The number of transbronchial biopsies performed by fellows was highest when on the lung transplant service. Surveys demonstrated that fellows perceived that the curriculum improved their knowledge and clinical skills.
Conclusions: A structured educational lung transplant curriculum improved Pulm/CC fellow performance on the ITE, provided fellows increased opportunities to perform transbronchial biopsies, and was perceived to be beneficial by participants.