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Pediatric Respiratory Medicine-An International Perspective

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Pediatric Respiratory Medicine-An International Perspective Pediatric Pulmonology 45:14–24 (2010) State of the Art Pediatric Respiratory Medicine—An International Perspective 1 2 3 4 Monika Gappa, MD, * Thomas Ferkol, MD, Tom Kovesi, MD, Louis Landau, MD, 5 6 7 Susanna McColley, MD, Ignacio Sanchez, MD, Asher Tal, 8 9 Gary W.K. Wong, MD, and Heather Zar, MD Summary. Although Pediatric Respiratory Medicine as a subspecialty has a long tradition and is well established in some countries, there is a wide variation across different regions of the world with regard to e.g. recognition of the discipline, training requirements, training facilities and clinical needs. This review summarizes the situation in North America (US and Canada), South America, Asia, Australia, Israel and Europe with the aim to highlight commonalities and differences and, ultimately, to further support continuous development of paediatric Respiratory Medicine Worldwide. Pediatr Pulmonol. 2010; 45:14–24. ß 2009 Wiley-Liss, Inc. Key words: education; curriculum; pediatric pulmonology. 1Children’s Hospital and Research Institute, Marien Hospital, Wesel, INTRODUCTION Germany. Worldwide, morbidity and mortality from respiratory 2Department of Pediatrics, Washington University, St. Louis, Missouri. diseases in children continue to pose a challenge to practicing physicians and healthcare systems. The prev- 3Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, alence and incidence of different disease entities varies Ontario, Canada. greatly from country to country and from region to region. 4 The University of Western Australia, Crawley, Western Australia, While the specific requirements for adequate care will Australia. vary accordingly, common standards for clinical manage- ment and for training of Paediatric Respiratory Specialists 5Department of Pediatrics, Northwestern University, Chicago, Illinois. are desirable in order to provide the best possible care 6 for children with respiratory diseases. Moreover, it is Department of Paediatrics, Pontificia Universidad Cato´lica de Chile, Chile. desirable that future pediatric respiratory specialists have insight and knowledge into the global issues in child lung 7Ben-Gurion University of the Negev, Beet Sheva, Israel. health. Currently, a Task Force from the Paediatric 8 Assembly of the European Respiratory Society is devel- Department of Pediatrics, Prince of Wales Hospital, University of Hong oping an updated curriculum for training in Paediatric Kong, Hong Kong, China. Respiratory Medicine (PRM) in Europe. As a result of the 9Red Cross War Memorial Children’s Hospital, University of Cape Town, work of this Task Force, an updated syllabus which Cape Town, South Africa. describes the content of specialist training in PRM in Europe has been published recently1 and the next steps *Correspondence to: Monika Gappa, MD, Children’s Hospital & Research Institute for the Prevention of Allergies and Respiratory Diseases in towards a full curriculum are being taken. Similar Children, Marien Hospital Wesel GmbH, Pastor-Janssen-Str. 8-38, developments are taking place in other regions interna- D-46483 Wesel, Germany. tionally, and these efforts to improve training in pediatric E-mail: [email protected] respiratory medicine may benefit from exchange between those involved in this task. Those in the process of Received 7 October 2009; Accepted 9 October 2009. developing standards and setting up formal training DOI 10.1002/ppul.21165 structures may learn from others, who practice in Published online 8 December 2009 in Wiley InterScience countries where PRM has already a long tradition as a (www.interscience.wiley.com). ß 2009 Wiley-Liss, Inc. Pediatric Respiratory Medicine 15 recognized subspecialty. There is a longstanding tradition Paediatric Division of the Royal Australasian College of of exchange of research fellows and clinical trainees Physicians and the Thoracic Society of Australia and New globally among some, but not all parts of the world. In Zealand. Those interested in a career in the discipline have order to further facilitate development of PRM it appears to complete a 3-year basic pediatric physician training desirable to understand the current conception of PRM in program in general pediatrics first with continuing different parts of the world. To increase awareness and assessment and a final multiple choice written and a transparency, for this review members of the international clinical examination. On successful completion, they pediatric respiratory community have been invited to commence 3 years of advance training in pediatric provide information about the status of PRM locally and to respiratory medicine. This training must be undertaken describe current standards of training and potential future in an accredited training site during which there will be developments. continuing workplace-based assessment with no require- ment for an exit examination. There are accredited training facilities in pediatric respiratory medicine in seven capital cities across Pediatric Respiratory Medicine in Australia Australia and New Zealand. A major concern is that most and New Zealand (Louis Landau) placements for training in pediatric respiratory medicine PRM has evolved as a distinct discipline in Australia are funded as registrar or fellow posts but many do not and New Zealand already from the early 1970s. Experts in have ongoing budgetary commitment so that availability PRM provide expertise to professional colleagues and the is dependent on access to the resources each year. These community in addressing the ‘‘new’’ pediatric pulmonary places are utilized for training by local graduates and morbidity including asthma, cystic fibrosis, congenital international trainees who have come mostly from abnormalities, sleep-related disorders, management of the Europe, North and South America, and Asia. acute and long-term respiratory illnesses in the extremely Advanced training sites for pediatric respiratory preterm baby and management of pulmonary complica- medicine must be accredited to ensure that they provide tions of the immuno-compromised child. The discipline high-quality clinical training against predetermined must continuously adopt useful new technologies related standards for facilities, supervision, case-mix, educational to endoscopy, ventilation, lung function measurements opportunities and infrastructure. These factors determine particularly in the younger child and sleep physiology. the length of training approved at that site and the numbers Guidelines have been developed for the management of of trainees that can be trained. common pediatric pulmonary conditions such as asthma, These standards include: cough, cystic fibrosis, home oxygen, and bronchiolitis. The specialty of pediatric respiratory medicine began to . Adequate supervision for core advanced training. This emerge in Australia and New Zealand from the 1950s usually requires a pediatric respiratory physician on-site following reports of retrolental fibroplasia with high most of the time and particularly when trainees are oxygen levels in preterm babies by Kate Campbell, of undertaking invasive procedures. The supervisor must measuring lung function in neonates by Eric Burnard and provide both formative and summative assessments to descriptions of childhood tuberculosis, aspiration, bron- the college. chomalacia, childhood wheezing and endoscopy by . Sufficient workload of clinical material encompassing a Howard Williams. By the 1970s Peter Phelan, having broad range of respiratory diseases. been trained by H. Williams and J. Mead actively . Access to appropriate clinical services for pediatric contributed to the establishment of an infrastructure to respiratory medicine such as pathology, microbiology train the next generation of pediatric respiratory physi- and radiology, clinical immunology and pharmacology, cians. In the late 1980s, the Australian Paediatric thoracic surgery, pediatric and neonatal intensive care, Respiratory Group was finally established across Aus- nuclear medicine, multidisciplinary clinics with allergy, tralia and New Zealand which now includes approx- gastroenterology and infectious diseases. It is desirable imately 60 members. This number of members provides to have access to specialized clinics such as those for an acceptable service across all sites, but needs some tuberculosis, cystic fibrosis, chronic neonatal lung growth to cope with attrition and increased needs of the disease, neuromuscular diseases, tracheostomy, and community. Most services are based in the capital cities outreach services. with long distances from many rural sites to access these . Sufficient workload to train in procedures such as services and workforce programs must address the needs fiberoptic bronchoscopy. of these dispersed communities. A respiratory function laboratory with adequate work- Training in PRM as a discipline in Australia and New load and a full range of testing procedures in infants and Zealand is managed through a Specialist Advisory children. The trainee shall report studies under super- Committee in respiratory and sleep medicine of the vision. The laboratory must also be accredited. Pediatric Pulmonology 16 Gappa et al. An accredited facility for the investigation and manage- training consists of scholarly activity, during which ment of respiratory sleep disorders. fellows develop and hone skills necessary to be successful . Suitable infrastructure for learning including scheduled as effective subspecialists, advocates, clinical investiga- regular interdisciplinary
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