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We read with interest the timely editorial by Gerrard Phillips (1), concerning the importance of providing physiological training to trainee respiratory physicians. This reviewed a French study indicating that trainees who had received an internship in a respiratory lab were substantially better at diagnosing respiratory abnormalities compared with trainees without such training. (2) Dr Phillips made a persuasive, “essential” case for an integrated understanding of respiratory physiology/pathophysiology, lung function testing and interpretation in clinical trainees.
We strongly agree and also argue that the problem is the recognition of the importance of physiology in general, across the specialist service. We are involved in work that aims to build physiologist numbers, leadership and lab capacity, and feel this could lead to improved training for trainee doctors, as has been shown in the audit of French trainees (2). This would very much benefit from further support from colleagues and hope that the following information helps to make this case.
In December 2015 the first NHS physiology scientist students of the new national NHS Masters in Respiratory medicine graduated from Newcastle University. This course is part of the national Modernising Scientific Careers (MSC) program in the NHS. The respiratory teaching faculty is consultant led, with delivery in hospital clinical teaching facilities.
Modernising scientific careers (MSC) is a UK wide initia...
Modernising scientific careers (MSC) is a UK wide initiative, led by the Chief Scientific Officer of the Department of Health to address training and education in healthcare science. This drew on stakeholder consultation in 2008 with policy proposals published in 2010. A central component of this initiative is a three year, part time Master of Science degree aimed at equipping future scientist leaders. The students involved include NHS employed Medical Physicists, Cardiologists, Vascular, Gastrointestinal and Respiratory Physiologists. These capacities are all relevant to Respiratory medicine and an integrated future training of Specialist trainee Physicians with scientists.
It is noteworthy, and a concern, that Cardiology trainee scientists have consistently outnumbered Respiratory trainees in the NHS scientist masters course (c.3:1). There are a number of potential explanations for this but we feel it is possible that some respiratory centres do not know of the program and the potential for fully funded trainee places. Funding is available covering both the MSc course and the salary of the scientists. This is made available following the provision of a business case made by individual departments and funds currently derive from demarcated regional education budgets and not the host Department or hospital. We feel this represents an important opportunity for capacity building for respiratory medicine, and the discussion raised in Dr Phillips editorial, indicating that internship in a respiratory lab led to better respiratory training for clinicians.
Precision, personalised medicine is exemplified by recent breakthroughs in Respiratory Medicine. These include the use of small molecule modulators of the Cystic Fibrosis Transmembrane Regulator (CFTR) channel in patients with Cystic Fibrosis lung disease. Future research of such approaches and measuring the efficacy of potentially transformational treatments in Respiratory Medicine is dependent on the capacity for U.K respiratory physiology and training for both clinicians and scientists. We feel that the current 4–5 year window to address respiratory physiology training for specialist training of Physicians highlighted by Dr Phillips is an opportunity for further coordination involving both Physicians and physiological scientists. The faculty developed for the training of NHS respiratory scientists in Newcastle would be very keen to pursue this with all respiratory colleagues.
Chris Ward, Ian Forrest, Graham Burns
1. How do we improve training in pulmonary physiology and the interpretation of lung function tests? Phillips G. Thorax. 2018 Jan;73(1):2-3. doi: 10.1136/thoraxjnl-2017-210140. Epub 2017 Oct 17.
2. Does training respiratory physicians in clinical respiratory physiology and interpretation of pulmonary function tests improve core knowledge? M Patout, L Sesé, T Gille, B Coiffard, S Korzeniewski, E Lhuillier, A Pradel, C Tardif, A Chambellan, C Straus, S Matecki, T Perez, L Thiberville, A Didier. Thorax. 2018 Jan;73(1):78-81. doi: 10.1136/thoraxjnl-2016-209136. Epub 2017 Mar 3.