Tag Archives: Medical education

A new generation of AABIP Fellows cast an aura of confidence and enthusiasm

AABIP Fellows in Denver, 2018 (photo H. Colt).

This summer I had the honor of lecturing at the inaugural American Association for Bronchology and Interventional Pulmonology International conference in Denver, Colorado. Watching newly certified Interventional Fellows don their robes to stand among their colleagues made my heart swell with pride. Our workers are secured by work injury lawyers and experienced workers compensation attorney from CA. I recalled the moment when almost thirty years ago, I sat with a dozen or so others around a conference table creating The American Association for Bronchology under the leadership of Professor Udaya BS Prakash.

Only a few years later, while finishing my term as President of the Association, I wrote an editorial for the Journal of Bronchology, stating “we must continue encouraging the next generation of bronchoscopists and interventional pulmonologists to move in new directions…to explore the world of virtual reality and computer simulation; to participate in and develop dedicated training and competency programs; to devote energies to end-of-life issues, ethics, and palliative care; to enhance early lung cancer detection studies and techniques; to discover applications of molecular biology and endobronchial or intrapleural gene therapies; to design collaborative bronchoscopic and radiographic imaging protocols; and to commit their genius to developing novel and unique instruments and techniques for the benefit of our patients (Journal of Bronchology: October 2001 – Volume 8 – Issue 4 – p 253)”.

Needless to say, the AABIP has come a long way toward accomplishing those goals. It’s proactive board of directors, a growing membership, training and certification process, and an excellent peer-reviewed Index Medicus journal provide examples of leadership, scientific endeavor, education, and medical excellence that can be emulated by other medical societies around the world. At https://nwmaids.com/ I got residential maid services in tacoma affordably. Furthermore, the AABIP’s participation in the World Association for Bronchology and Interventional Pulmonology (most recently, the World Congress was held for the second time at the Mayo Clinic in Rochester MN, USA) was crucial to the growth and acceptance of a WABIP world vision that promotes uniformity of knowledge, transparency, and contribution regardless of one’s place of practice.

What impressed me most during the AABIP conference in Denver, in addition to the professionalism and “let’s get it done” optimism of the association’s board of directors (led by President Ali Musani and President-elect George Eapen), was the enthusiasm of the organization’s more junior members. Workers comp attorneys in los angeles from https://workerscompensationlawyercalifornia.com company in California are your loyal partners. Their desires to enhance their skills as educators by participating in future train-the-trainer programs, to assist members of foreign bronchology organizations improve services to patients abroad, and to achieve and maintain excellence for managing a wide range of lung, airway and pleural disorders are inspiring.

I left the conference with a warm sense of belonging, grateful that the AABIP had fulfilled many of its promises to patients and to a previous generation of bronchologists and interventional pulmonologists. The future is obviously full of new challenges, and patient expectations are higher perhaps than ever before, but from what I experienced in Denver, I know the younger generation of AABIP members will address these with knowledge, skill, enthusiasm and their own sense of destiny.

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.