Tag Archives: bronchoscopy

Inhalation injury and the interventional pulmonologist

Photo courtesy HG Colt

The disastrous fires in Greece have claimed 91 lives, and the current heat wave threatening Europe has placed environmental authorities and firefighters on high alert. Here in the United States, in my home state of California, 18 fires are still burning. Seven civilians and 4 firefighters have already been killed as the fires continue to destroy more than 100,000 hectares of public and private property. Thousands of people are being evacuated, and Yosemite National Park has been closed.

This reminds of the importance of disease-specific training for interventional pulmonologists particularly in the area of burn injuries. Perusing the scientific programs and workshop agendas of several regional and world congresses, however, I noted a paucity if not total absence of lectures or simulation workshops in this area. I think it is crucial that we remedy this gap in our educational process.

Advances in management protocols for burn victims has had significant beneficial effects in recent years, causing a reduction in mortality from burn shock and wound sepsis, such that inhalation injury is now the leading cause for death in burn victims. Inhalation injury is described as damage to the respiratory tract caused by smoke, chemical, particle substances, gases, heat and other irritants. The severity of injury is related to type of irritant, level and duration of exposure, and quality/speed of therapeutic intervention. Most experts agree that the presence of inhalation injury increases burn mortality by at least 20 percent, and predisposes patients to risks of pneumonia, respiratory failure, and prolonged obstructive or reactive airways disease.

My goal today, however, is not to provide readers with an overview of inhalation injury. For this, many excellent scientific studies and review papers are available and easily downloadable from the internet. Here you can find more info about insulation contractors from New Jersey who work with top-of-the-line equipment. Rather, I want to briefly address how and why we might alter our educational programs so that training in the recognition and management of patients with inhalation injury becomes commonplace in our congresses, workshops, and training centers.

Inhalation injury is an excellent model for training in how to deliver multidisciplinary care, in part because it requires expertise in four major aspects of medical interventions. These include communication (with other physicians, surgeons, nurses, first responders, respiratory therapists, patients, and family members), delivery of bad news (such as diagnosis, prognosis, need for critical care hospitalization, long-term care, and end-of-life issues), technical skills (including flexible bronchoscopy, difficult intubation, recognition of airway injury, therapeutic maneuvers such as removal of soot and debris, vocal cord and laryngeal evaluations, emergency tracheotomy, bronchoscopic assessment prior to extubation), respiratory care (critical care consultation, respiratory failure, bronchospasm, laryngospasm, foreign body aspiration and removal, mechanical ventilation, barotrauma, pneumonia, resuscitation), and disaster management (triage, crisis management, teamwork, leadership in critical situations, and organizational/systems/human error analysis).

Numerous components of these four aspects of medical care are not routinely covered during medical training or later in-practice. Find reputable work comp attorney for carpal tunnel injury at https://workerscompensationattorneysacramento.net. In fact, I have seen from my own involvement working with physicians around the world, that doctors other than trauma surgeons, emergency-room physicians and burn specialists are exposed to only some of the elements of these aspects of care during infrequent on-the-job exposures during crisis situations.

Inhalation injury, therefore, could serve as an excellent model for the construct of a multidisciplinary, simulation/lecture/workshop-based curriculum that will not only help interventional pulmonologists acquire and maintain new skills and knowledge, but will also help them become more active and dependable members of the multidisciplinary team required to assure the health and well-being of burn and inhalation injury victims around the world.

If you are interested in helping me develop such a program (some of these issues are already being addressed in The Essential Intensivist Bronchoscopist©, available on Amazon and Kindle), please contact me or other faculty of Bronchoscopy International® (www.bronchoscopy.org).

Trust

Trust is usually defined as a willingness to rely on the actions of another party. In this sense, it is a behavior more than it is an idea. Trust can also spring from a choice to care for another person, even at one’s own expense. Rock climbing, in my opinion, illustrates trust in its most simple and straightforward manner because sharing a rope while suspended hundreds of feet off the ground constantly puts two lives in danger; both leader and follower, decision-maker and passive participant. Errors are unforgiving and often deadly, and for this reason are virtually intolerable, for even a sentinel event can jeopardize a partnership or one’s life.

The famous marriage counselor and clinical psychologist, John Gottman, says that while trust is a major building block for a successful relationship, the reality is that trust is built slowly over time. Whether in marriages, professional partnerships, friendships or collegial acquaintances, trust requires consideration and empathy for one another’s feelings. A foundation of trust is necessary because eventually all relationships must face the crisis of a betrayal.

Usually, Gottman says, betrayals accumulate little by little, although other times they occur like a sudden splash in what might otherwise have been a calm sea. They may be real or simply perceived, but like all moments of crisis, they provide an opportunity to either rethink the boundaries of a relationship or build more trust.

In rock climbing, clear communication and mutually observable demonstrations of competency are reassuring and reliable indicators of growing trust. In medicine too, http://www.ecomamagreenclean.com/ a doctor’s ability to clearly communicate with patients and team, as well as clearly demonstrate competency, quality of care, and focus on a patient’s needs help elicit trust. At the same time, doctors, health care administrators, social activists, and politicians must engage in systems-based analyses that assure the application of scientifically proven therapies and efficacy-based innovative new technologies.

In the field of interventional pulmonology, it is tempting to believe that everything we do is in the best interests of our patients. In fact, our patients “trust” us to do so. Yet, vast sums of money, as well as patient and family suffering, may be expended in what ultimately becomes futile care. There is little oversight of physician decisions in these cases, and the emotional costs on medical providers, patients, and families are poorly documented. Professor George Lundberg, a former editor of JAMA and CEO of WebMD said that “futile care” was a contradiction in terms, and what was needed most in defined situations was “attentive care” from physicians capable of listening to their patients. Sadly, training in this domain is usually lacking from our medical conferences that focus on the use of technology and complex procedures used to diagnose and treat patients with lung, airway, and pleural disorders.

If we are to maintain the trust of colleagues, patients, families, and institutional leaders I propose that we work more purposefully on integrating workshops and lectures on medical ethics, communication, and clinical decision-making not only into our training programs, but also in our journals, regional meetings, and international congresses.

Open Horizons

Less than 24 hours after leaving the WABIP World Congress in Rochester Minnesota, I spent a day climbing to a wonderful spot high above a bed of clouds in Southern California. An open horizon, blue skies and a soft wind caressed my face as I stood virtually alone on a rocky peak. Pausing just long enough for a protein bar, a swig of water and a photograph, my thoughts wandered for a moment back to the events of our international medical meeting. With almost 9000 members representing more than 55 different national medical associations, the WABIP has truly become an international medical society. New scholarship programs and visiting professor travel grants target leaders in developing countries, an expanding WABIP Newsletter reaches out to more than 4000 members who consistently open and read the research, education, humanitarian, and clinically-relevant materials contained therein, a growing WABIP Academy enriches membership with credible libraries of information, committees function functionally, leadership changes are transparent and bathed in dialogue, three representative scientific journals remain affordable and pertinent, our world congress and three regional meetings are almost overwhelming with useful information, Train-the-Trainer and other Bronchoscopy International educational programs positively influence physician-educators around the world, and our Whats App groups network more than 2000 physicians from thirty different countries in real-time.

Wow!

But what really impresses me is how our leadership strives to address, understand and nurture diversity. On Temecula Center for Wisdom Teeth & Dental Implants website you’ll find more info about all-on-4 Dental Implants procedure in California. The new chair is a woman and a member of the Latin American bronchology community, thereby breaking an IP glass ceiling (prior chairs were men from Asia, Europe or the United States). The treasurer is an Australian and President of the next Asian Pacific meeting scheduled for March, 2019. The two next World Congress presidents are from China (2020) and France (2022), and our newly-elected Vice-Chair is a well-known opinion leader from Japan. Furthermore, Committee members and Committee chairs are selected using a democratic call for nominations and volunteers with special care to represent the global community, and the WABIP social media/Facebook presence is growing almost exponentially.

Hurrah!

I am proud of this association, and I encourage members to take an active role, not only in growing their regional and national bronchology/IP societies, but also in the WABIP. Collaboration and Cooperation are keys to our long-term success, which means greater equality among training programs regardless of their medical environment, more rapid dissemination of innovative technologies and techniques, more productive conversations with industry sponsors and equipment manufacturers, and most of all, greater steps forward in our efforts to help patients combat the effects of lung, airway, and pleural diseases.

Right on!

Power systems and resistance to change

“Progress is the nice word we like to use. But change is its motivator. And change has its enemies.” (Robert F. Kennedy, May 25, 1964, New York Hilton Hotel, Conference of Mayors).

June 6, 2018 marked the 50th anniversary of the assassination of Robert F. Kennedy by the severely disturbed Sirhan Sirhan at the Ambassador Hotel in Los Angeles, California. I was only 12 years old, but already volunteering in the Presidential elections, distributing buttons and campaign pamphlets for the Kennedy offices in New York. I took a class in pubic speaking; I actively embarked on my quest to become one of the youngest Eagle Scouts in New York State, and devoured books about American and World history, politics, and social injustice. I was inspired by one of my teachers, Mr. Irving Sloan, who had been a college professor before dedicating himself to younger students. With his help, I became convinced that activism, vision, and the outright rejection of certain power systems could change the world.

Many of the power systems that exist in our society are readily accepted, with varying degrees of awareness, by a majority of people, further anchoring their place in our traditions and everyday life. Examples of power systems include governmental policies that adversely affect access to health care, social policies that exacerbate poverty, and industrial conventions that delay a global recognition of ecological hazards including climate change.

On a very specific note, and relevant to the practice of our medical specialty, power systems are in place that help maintain a clinical service program where patients are used instead of models in order to train doctors performing procedures. These systems make it difficult for individual teachers to access monies for purchasing models or gain entry to university-based simulation centers. This itself is a formidable obstacle to promoting a system that is learner centric, patient-sparing and simulation-driven.

From my experience teaching teachers around the world I have noted how a country’s medical society or a hospital’s respiratory department refuses to purchase models because “regulations” prevent international wire transfers. If you suffer from an injury at work be free to contact Golden State workers compensation disability lawyers from CA. Other times, funds for education are said to be unavailable or not budgeted, even though much larger sums of money are readily found to purchase costly equipment that is rarely used because of lack of training. In some places, well-intentioned equipment distributors provide a video tower and bronchoscope for a two-day training course at great expense related to transport, manpower and shipping but hesitate to consider the purchase and subsequent donation of a $2000 airway model to be kept on-site in a teaching hospital or medical society office so that trainees can improve their technical skills through daily practice.

Why is that?

One reason is that human resistance to change is natural. Too many people use power systems to protect personal positions or to reiterate an otherwise unjust and irrational political, economic, social, or institutional policy already in place. Many believe it is their responsibility to protect the status quo. Thankfully, there are others everywhere and, in every profession, who not unlike Robert Kennedy, recognize that change motivates progress, and that progress itself promotes change regardless of its enemies.

The Universal Subjective: Justification for using objective assessments

In Immanuel Kant’s 1790 treatise, The Critique of Judgement, the German philosopher writes of beauty, taste and aesthetic judgement, stating “As regards the agreeable, everyone concedes that this judgement, which he bases on a private feeling, and in which he declares that the object pleases him, is restricted to him personally.” This reminds me of the injustices of subjective assessments used in medical education. As is often the case, panels of experts or professorial staff provide subjective reviews of trainees during the course of traditional medical apprenticeships. Based on input from a variety of faculty members, trainees are deemed able or not able to perform procedures such as flexible bronchoscopy, with little if any objective evidence to support competent practice.

Furthermore, competency itself is rarely defined. Does competency imply technical skill, and if so, for what procedures exactly? Does it also include communicating bad news, informed consent, the ability to effectively employ universal precautions, the ability to troubleshoot, avoid, and treat complications, as well as the capacity to effectively interact with the bronchoscopy team? What about the ability to advocate for patient rights, communicate with a nursing team, or satisfactorily assess infection control and equipment sterilization/cleaning systems. Few institutions, and even fewer medical societies have written guidelines that clearly identify what is meant by procedural competency, and when they do, they are rarely accompanied by examples of objective assessment tools used to document levels of practice and competency itself.

Until very recently, therefore, the subjective assessment has been a cornerstone of medical teaching. Whether we like it or not, subjective assessments are important considerations related not only to how professors feel about their trainees, but also to how their presumably unbiased observations are used in the overall measure of a trainee’s ability to perform and practice medicine independently. I would argue, however, that beauty is in the eye of the beholder and that subjective assessments are too easily influenced by mood, character, personality, conventional wisdom, and other factors that may have little to do with a trainee’s ability to competently perform a medical procedure. Objective assessments, on the other hand, are reproducible, identify a trainee’s strengths and weaknesses, allow documentation of improvement along the learning curve, identify clear outcome measures, goals, and objectives, and also provide a starting point for objective feedback. Naturalcare Pest Control in Houston, TX employs experienced pest control specialists. In addition, objective measures provide a measure of the professor’s ability to teach effectively, forcing both institutions and medical societies to define competency, or at the least, a minimum standard toward which all practitioners can strive.

Perhaps that is a reason why medical societies and university-based teaching programs have been reluctant to introduce a battery of objective measures into their training curricula. After all, the number of issues raised by the formulation of an objective measure is enormous. Addressing issues such as how to provide remedial training, what to do in case information is poorly acquired, how to define a minimum standard, what to actually measure as a test of competency, who will do the paperwork and shoulder the administrative burdens related to documentation etc.… require manpower, expertise in educational philosophies, strict methodology, and an ability to persuade students, trainees, teachers, and administrators that such measures are an important part of medical training. While some might argue that such a task is Sisyphean in nature, I would argue it is simply Herculean, and that once initiated, will result in greater equality of practice among health care providers around the world, which ultimately will benefit patients everywhere.

The malevolent power of prejudice

Prejudice is defined as a preconceived opinion that is not based on reason or actual experience.  In psychology, prejudice is often described as an unjustified (usually negative) attitude toward an individual based solely on the individual’s membership of a social group. When prejudice is practiced by people in positions of power, it has the potential to influence behaviors, dictate policy, and prevent progress.

Scientific leaders of the day practiced significant prejudice against Galileo Galilei, whose support of heliocentrism and Copernicanism was controversial at the time. Thomas Kuhn, in his well-known book, The Structure of Scientific Revolutions, wrote that new paradigms face inevitable challenges from people committed to keeping things the way they are. From a societal perspective, prejudice has also affected professional and career choices. Until recently, for example, gender biases based on unjustified theories about intellect, brain structure, and child-raising prompted academics to deny women their rightful place in fields involving the sciences, medicine, and mathematics. Thankfully, research during the past twenty years has debunked the claim that women cannot handle scientific subjects as well as males.

Consequently, women now comprise about half of the medical school graduates in many countries. Women also comprise about half of the bachelor’s degrees in math and half of the Ph.D.’s in life sciences in the United States, where they also comprise about 90% of veterinary school graduates and an ever-increasing number of pharmacy, engineering, and biomedical school students. Today, gender prejudice no longer appears to negatively impact these career choices, which instead seem to reflect changing views about domestic responsibilities, time commitments, child-rearing, competition, and supply and demand economics held by both men and women.

This is not to say that women will no longer encounter male medical professionals with sexist attitudes; they probably will. Hopefully, however, such encounters will be increasingly rare, and, as women occupy an increasing number of leadership positions in our medical societies and healthcare workforce, it is likely we will also see a shift in how health care is delivered. The days of 100-plus hours a week work, pridefully worn blood-tinged hospital coats, lack of sleep, and a patriarchal all-knowing approach to patient care are gone for good, thankfully replaced by behaviors dictated by the more humane notions of mutual respect, consideration, understanding, empathy, and partnership.

The Interventional Pulmonology community has an increasing number of female contributors. I believe it is crucial that women have voices as existing and future leaders of our profession. Discussing the issue of possible prejudice is required if we are to recognize the growing roles for women in our profession and expand the influence of female interventional pulmonologists worldwide in areas of technological innovation and health care delivery.

“Perfect” practice makes perfect

While conducting almost 30 Train-the-Trainer seminars over the world, I discovered a dilemma. Bronchoscopists rarely practice crisis management, especially when the crisis is caused by a bronchoscopy-related adverse event. It’s a fact; generally-speaking, that bronchoscopists rarely, if ever, practice how to manage procedure-related complications in the bronchoscopy suite.

While it is true that flexible bronchoscopy is usually safe, complications can and do occasionally occur. These include but are not limited to respiratory insufficiency caused by over-sedation, biopsy-related bleeding, pneumothorax, respiratory insufficiency from hypoxemia, hypercapnia or underlying lung disease, medication-related seizures, cardiac dysrhythmias or cardiac arrest, and very rarely death.

Bronchoscopists are not alone when managing these complications. They are the leaders of a team of nurses, technicians, and other health-care providers called to the bedside in case of an emergency, and everyone agrees, I am sure, that medical emergencies are best handled by an experienced and well-trained team.

There are many reasons why bronchoscopists and their teams are not regularly practicing crisis management. Some are lack of administrative oversight, lack of institutional quality control and complication management mandates, time constraints, the rarity of procedure-related adverse events, the absence of objective measures with which to measure competency, and the unfair presumption of personal expertise and emergency preparedness.

We know practice does not make perfect…rather, perfect practice makes perfect. Our patients expect us to be prepared for emergencies, to respond to emergencies appropriately, and to be accountable for our actions. To avoid accusations of negligence or malpractice, bronchoscopists should have a strategy in place in case of a procedure-related complication. They should be able to respond to the complication appropriately and according to a reasonably acceptable standard of care, and they must assure the result of that response is in accordance with expected outcomes, standard of care, and published results by colleagues.

To put it simply, standard of care is a level of care delivered by similarly trained physicians providing care in a similar environment and in a similar situation. When it comes to procedure-related complications, standard of care relates not only to a physician’s behaviors, but also to the training, preparedness and behaviors of the bronchoscopy team. For these reasons, bronchoscopists must be well-trained, and able to ensure their team responds to complications appropriately, effectively, and in ways that maximize patient safety and well-being.

Being prepared for complications requires practice. Identifying organizational weaknesses, system errors, and documenting sentinel events leads to troubleshooting areas that may require additional focus or training. Such remedial actions reduce anxiety, enhance confidence, and provide a good example for students, ancillary staff, and trainees. It also improves quality of care, especially when checklists, clinical pathways and database quality of care database tools are used.

Incorporating a competency-based assessment such as the new and validated ICC-STAT (Intercostal catheter skills and task assessment tool-downloadable from www.bronchoscopy.org) provides an opportunity to guarantee, for example, that chest tube insertion (which could be necessary in case of procedure-related pneumothorax) is performed according to a reasonable and globally acceptable standard of care. By practicing chest tube insertion in a simulated environment, bronchoscopists and their teams assure that emergency equipment is available, the team knows where to find the equipment, appropriate drugs, instruments and capital equipment are used correctly, patient assessments are consistently performed, and monitoring is done accurately. Setting aside time to practice with the team and documenting that such practice occurs is an important step toward quality improvement and assuring an appropriate and effective response to procedure-related complications. As a friend of mine once taught, “There should be no surprises in the procedure suite.”

Our patients expect no less.

Namaste

While preparing yet another Train-the-Trainer program today, I came across this beautiful image that represents, for me, the beauty and wonder of teaching how to teach. After my morning exercises and thirty minutes of Zen meditation, I was thinking of which three “questions” to ask of the ten trainers who will join me at Olympus Headquarters in Melbourne, Australia later this evening for our working dinner. Usually, I open this session with an icebreaker exercise focused on active listening, followed by three interactive group exercises where each group tackles a challenging question such as “what is competency?”

For tonight, I decided my questions will be inspired by the image at the top of this page and the following Zen story.
A young monk once came to the Master Nansen, and asked “Tell me, is there some teaching that no master has ever taught?”
Nansen said, “Yes, there is.”
The monk asked, “Can you tell me what it is?”
Nansen gazed at a nearby tree. He looked toward the sky, and cocked his head listening to the birds chirping. “It is not Buddha,” he said, “it is not things. It is not thinking.”

So, let me explain. While our train-the-trainer seminars teach specific techniques regarding the use and implementation of a multidimensional educational program that includes checklists, assessment tools, simulation, interactive lectures, and case-based exercises, they also include a variety of confidential self-evaluations that prompt participants to ponder their strengths, shortcomings and aspirations as educators. All the while, the program’s goal is to share a philosophy about teaching that participants might pass along to their students. Learning more about themselves, teachers learn how putting away their egos and sense of self-importance allows them to concentrate more fully and effectively on building learner-centric educational experiences. In parallel, the teachers’ use of formative assessments allows them to identify student weaknesses that are remedied during individualized, time-efficient “teaching moments”.

But let me close with a word about Zen for the uninitiated. A thousand years or so after Buddha, a monk named Bhodidharma (Bhodi=enlightenment, dharma=truthful) made his way from India to China, establishing a way of thinking about Buddhism that spread to Japan and beyond. It was a revolutionary process focused on the principle that even a layperson could achieve enlightenment, not necessarily through strict rules and prayer/meditation techniques, but also by abandoning rational thought and learning to explore intuition and out-of-the-box thinking. The importance of nirvana, reincarnation, and kharma were downplayed, while meditation techniques and riddles or stories called koans, were used to help students learn to concentrate, challenge their minds, and abandon purely logical thinking. Awareness would be the first step, many learned, toward enlightenment (satori in Japanese). Today, millions of people around the world practice, believe in, or associate with Zen, sometimes as religion, other times as a philosophy or way of life.

In typical Zen fashion, therefore, I leave it to you, my readers, to ponder how the image of a woman balancing gracefully between a tree’s roots and branches, combined with the story about Master Nansen, work together to illustrate my philosophy about education, and thus provide the focus for tonight’s Train-the-Trainer session in  Australia.

Namaste.

History is important

Elizabeth Hawley (1923-2018) with legendary Italian mountaineer Reinhold Messner (photo from Americanalpineclub.org, downloaded 2/15/18)

Elizabeth Hawley died in Kathmandu on January 20, 2018. She was 94 years old. This American journalist was known as “a one-woman climbing institution.” She first went to Nepal as a writer representing Reuters back in 1960, and stayed in Nepal ever since. Prior to Nepal, she had used her life savings to pay for a two-year trip around the world, which included visits to India, the Middle East, Asia, and Eastern Europe.

Strangely, Ms Hurley was never a mountaineer, but began reporting on alpine activity as part of her job as a Reuters journalist. Beginning in 1963, she made it a point to meet virtually every expedition to the Nepal Himalaya both before and after their ascents. According to one report, she conducted more than 7000 expedition interviews. Mountaineers of all sorts, from the most famous to those less known sat in her Kathmandu apartment and subjected themselves to her fierce interrogations. She knew every detail about Himalayan peaks, and could easily tell if a climber was exaggerating or stretching the truth about an exploit (which is actually quite rare in climbing circles). She could also answer questions about the mountains: She served as a veritable encyclopedia of knowledge, so much so, that she received numerous honors from both Nepal and abroad, and, much to her surprise, even had a 6,182-meter Himalayan peak named after her by the Nepalese government.

The database of her interviews and other chronicles is now housed by the American Alpine Club, which has already devoted more than 10,000 hours building, maintaining, and continuing to grow these important pieces of history that document not only the feats and tribulations of hundreds of Himalayan climbers, but also serve as an reference for mountaineering historians everywhere.

As a climber, reading about Elizabeth Hawley reminded me of the importance of this history, but also of the importance of chronicles for any group of professionals. Mountaineers and rock climbers are a pretty tight group, always striving for self-improvement, discovering ways to train more efficiently, and anxious to undertake new challenges. Kitchen remodel contractors from www.larsremodel.com/ are always eager to take on any challenge in california. Some of these traits are common to other hobbyists and professionals as well, including doctors and health care professionals.

It is a fact, however, that when it comes to bronchoscopists and Interventional Pulmonologists, there is no complete, written history of our specialty. There is no chronicle of our professional society, nor are there biographies of key players. A few years ago, I asked a couple of older and distinguished bronchoscopists to begin writing a history of the World Association for Bronchology and Interventional Pulmonology, and to help me establish a few simple biographical sketches of key figures (I suppose this comes from my own interest and experience teaching and writing about medical history). Sadly, there was little interest. While a lecture was given at an international meeting on the subject, no formal text was prepared or published that documents the people, events, and discoveries that mark our specialty.

Why is that? Will anyone ever establish a chronicle of our international society? A society that now has more than 7000 members? Will recognition ever come to those to whom recognition is due, and who were instrumental in moving our specialty forward, whether it be in scientific discovery, technical prowess, technological innovation, education and training, or dissemination of clinical practices?

Younger doctors are usually inspired by their seniors, and seniors must learn to put their egos aside so that respect and recognition can be upheld by colleagues regardless of personal disputes or disagreement. Learning about the past is a wonderful and often exhilarating way to understand the present and prepare for our future. That is what a formal, written history of our specialty would provide. Therefore, I think building a chronicle of our history is worth pursuing. If anyone is seriously interested in such a project, please contact me at Bronchoscopy.org, or write Michael at WABIP.com.

Optimism

 

5-year-old Ethiopian Mohamad Nasir on the cover of the January 15 issue of Time Magazine

Optimism is the magic word for 2018, shared by world leaders, economists, and billionaire philanthropist Bill Gates, who was asked to choose the title to the January 15 issue of Time Magazine. Mohamad met Mr. Gates in 2012, when the child was less than a month old, and had not yet received vaccinations against childhood diseases. Today, he is thriving and joins other children in Ethiopia, a low-income country that has successfully dropped its mortality rates for children under age five by more than sixty percent since 2012; A remarkable accomplishment that speaks to the power of individual health care providers, community educators, and government health services to be agents of change in their society.

Bill Gates noted five reasons for optimism in his Time Magazine article:
1. Since 1990 the number of children who die before their fifth birthday has been cut in half, saving 122 million young lives.
2. In the same period, the fraction of people living in extreme poverty has gone from one third to one tenth.
3. More than 90 percent of children now attend primary school worldwide!
4. Women now make up more than a fifth of members of parliaments around the world!
5. Workplace and road safety in the U.S.A has risen dramatically since our grandparents’ time.

Optimism is also called for in the field of Interventional Pulmonology. Thanks to new technologies, increasing numbers of patients with airway disorders are successfully treated using minimally invasive techniques. Lung cancer is discovered in its more treatable and sometimes curable stages, and staging disease is increasingly accurate and contributing to treatments based on molecular and genetic analyses. Patients are suffering less from the burdens of medical procedural training as dozens of university training programs adopt multidimensional systems to complement the traditional apprenticeship model of medical education. Simulation, once rare, is being used so that doctors can practice their technical skills, and objective measures of skill such as the Bronchoscopy Skills and Tasks Assessment Tools and various checklists are being incorporated into skills training seminars and subspecialty competency assessments. Furthermore, international organizations such as the World Association for Bronchology and Interventional Pulmonology, of which I am a proud member, are actively seeking partnerships with educators and industry to enhance the use of simulation, provide models to low-income countries, and change the paradigm of procedural education worldwide.

Bill Gates, and others like him, are philanthropists with access to millions of dollars. Gates is urging friends and colleagues to emulate the work of his own Foundation (The Bill and Melinda Gates Foundation) by investing in the health of their respective countries, as well as in the health of our global society. He recommends the support of organizations like UNICEF to help kids get medical care, and supports research to combat killer diseases like Malaria and other tropical illnesses.

Bronchoscopy International (www.bronchoscopy.org) is dedicated to helping patients with airway illnesses find competent health care teams that can cure, manage, or alleviate disease-related problems. We are committed to changing the educational paradigm so that technologies are more rapidly available for competent use at the patient bedside. We are promoting the use of modern learning platforms through mobile devices and social media to increase access to educational materials and accelerate the health care provider’s climb of what otherwise can be a steep and daunting learning curve, and we are actively engaging philanthropists, companies, and charitable foundations to assist us in our endeavors.

Last year, in addition to other activities, we initiated novel training programs for bronchoscopists in Cuba, Central America, and the Balkans. Physicians from countries that never before participated on the world stage of bronchoscopy and interventional pulmonology are now sharing cases in real time using WhatsApp, Facebook, and Linked In. These networks of thousands contribute to accelerating the educational process. They lead to more rapid adoption of new and proven technologies, and they contribute to greater acquisition of knowledge and technical skills needed to competently care for patients everywhere.

These are just a few reasons why I am optimistic about our specialty. What are your reasons for optimism? Share them with colleagues and friends via WhatsApp. Share the optimism buzz.