Abstract
HERMES proposes a detailed, interprofessional and multidisciplinary curriculum for training in thoracic oncologyhttp://ow.ly/H1A9301jVpx
一个人的力量,即使无所畏惧和专注,这是强大的,但是许多人一起工作的力量更好。
Gloria Macapagal Arroyo
Thoracic oncology is a rising discipline that is evolving towards being a specialised multidisciplinary activity. Multidisciplinary teams (MDTs) are playing an ever important and increasing role in the management of thoracic malignancies in the lung, pleura, chest wall and mediastinum. These teams have a great potential to improve patient care and the healthcare system [1]。胸部肿瘤学MDT表示来自不同背景的一组医疗专家,专业知识为患有胸腔恶性肿瘤的患者提供高效和全面的护理。
Among thoracic malignancies, lung cancer has a significant worldwide impact because it is estimated to cause 1.59 million deaths worldwide, as reported by the World Health Organization [2]。The epidemiology of this disease has evolved at an astounding rate such that, at present, it is considered a pandemic with major financial and social consequences. Hardavellaand Sethi[3] discussed challenging perspectives and future needs in lung cancer care, which include novel diagnostics and therapies anticipated to improve survival and outcomes, risk factors such as asbestos and smoking, lung cancer screening, epidemiological databases, changing trends of the disease, the late stage at presentation, and socioeconomic changes such as austerity measures in Europe. With these challenges, lung cancer care is generally characterised by a coordinated, multidisciplinary, process-oriented approach. As in lung cancer, the multidisciplinary approach would play a critical role in the management of thoracic malignancies as well. This is due to the increasing wealth of information, and the complexity of various medical procedures and interventions. In Europe, treatment is provided by physicians from different specialties, and is increasingly subject to regulations and quality control. In Belgium, for example, laws have been developed to regulate cancer care. Seven oncology-specific laws have been put in place, the first defining the multidisciplinary oncology consultation and allowing reimbursement for such care. Almost all innovative and expensive drugs are reimbursed only if all members of the MDT agree that they would benefit an individual patient [4]。
The European Respiratory Society (ERS) recognises the need to tackle these challenges and improve the quality of care received by those suffering from thoracic malignancies. The ERS Thoracic Oncology Assembly and the HERMES (Harmonising Education in Respiratory Medicine for European Specialists) initiative work together to develop educational standards. The Thoracic Oncology HERMES Task Force has recently published curriculum recommendations for training in thoracic oncology [5]。The curriculum recommendations further develops the syllabus published in 2013 [6]。The Task Force has proposed a detailed curriculum containing a sophisticated blend of educational strategies, content, learning outcomes, educational experiences, assessment and educational environment [7]。
The Thoracic Oncology HERMES Task Force aims to address the training needs of the members of the MDT, any of whom can lead a thoracic oncology MDT team with appropriate training. Additional training will make these specialists more efficient in their interaction with the patients and fellow physicians. GAga等。[8] discussed the importance of high-volume specialised centres and MDTs, and advocated that treatment of patients with thoracic tumours should be concentrated where all the involved specialties are available. These specialists will need to be certified for their competence.
This curriculum details how to train to become a thoracic oncology specialist. According to the understanding of the Task Force, thoracic oncology specialists are expected to be well experienced clinicians who treat thoracic malignancies in a specialised centre. The target audience of this curriculum is respiratory physicians, medical oncologists, radiation oncologists and thoracic surgeons. Each of these specialists is familiar with the collaborating disciplines. This permits them to understand and appreciate the contribution of each. Thoracic oncology specialists are therefore in a position to lead a multidisciplinary thoracic oncology team and chair the tumour board.
The curriculum modules were formulated by the Task Force keeping in mind the concept of the thoracic oncology specialist.表格1shows the 22 curriculum modules.
胸部肿瘤学Hermes工作队由两把椅子Anne-Pascale Meert和Fernando Gamarra领导,以及一位协调该小组活动的医学教育专家Julie-LynNoël。选择其他成员代表胸部肿瘤学涉及的医学学科:呼吸医学,医学肿瘤学,放射肿瘤学和胸外科手术。ERS活跃成员的呼吸医生和医学肿瘤学家包括:Mina Gaga(希腊),Bogdan Dragos Grigoriu(罗马尼亚),Rudolf M. Huber(德国),Sam Janes(UK)和Jean-Paul Sculier(比利时)。佐治亚·哈达维拉(Georgia Hardavella)(英国)代表ERS胸部肿瘤学大会的初级成员。此外,还包括病理学家Philipp A. Schnabel(德国),专门研究胸腔肿瘤。该工作队还与其他欧洲社会合作:吉尔伯特·马萨德(Gilbert Massard)(法国),德克·范·雷姆多克(Dirk van Raemdonck)(比利时)和亚历山德罗·布鲁内利(Alessandro Brunelli)(英国)作为ESTS的官方代表(欧洲胸外科医师学会)。萨拉·拉梅拉(意大利)和保罗·马丁·普托拉(Paul Martin Putora)(瑞士)代表Estro(欧洲胸部放射疗法和肿瘤学会);ESMO(欧洲医学肿瘤学会)选择了Enriqueta Felip(西班牙)和Anne-Marie C. Dingemans(荷兰)作为医学肿瘤学专家。有关工作队成员的隶属关系,请参见“确认”部分。为了说明欧洲的不同标准,选择了工作队成员来代表尽可能多的欧洲地区。
National respondents played an important role in the curriculum development. At the beginning for the syllabus development, they were expert respondents in the Delphi process, which was crucial for the content development. At this phase of curriculum development, they gave valuable feedback and validated the content. The national respondents consisted of experts nominated by the Forum of European Respiratory Societies in 2011 and the national coordinators of the European quality management in lung cancer care [9]。
Contemporary concepts of medical education like Bloom's taxonomy of education objectives and Miller's model of clinical skills were applied [10,11]。Medical education specialists gave guidance on the concepts used. The curriculum is meant to be used as needed, and fit for the context of the trainee and trainer. The aim was to go beyond the mere list of topics and provide the learning outcomes, including the levels of complexity and assessment, in detail for each item. The curriculum gives concrete advice for the development of a training programme including the methods of assessment and the minimum clinical exposure times and patient numbers. With this information, trainees and trainers will be able to appraise what is needed and determine a unified education strategy to become a thoracic oncology specialist. The supplementary material to the curriculum on theBreathewebsite contains the complete module 22 (Quality and economic considerations in lung cancer treatment) [5]。
Those who would complete the thoracic oncology training are already specialists in a discipline that is involved in the treatment of thoracic malignancies. Accordingly, the prerequisites to complete training would include being a specialist in a discipline that is involved in the diagnosis and treatment of thoracic tumours, and to have a recognised certificate in the country in which the learner is currently working. The Task Force recommends a minimum of 12 months of full-time training and a maximum of 24 months depending on the size of the institution or centre in which the training takes place. It is therefore a prerequisite to have an already recognised certificate in the country in which the applicant is currently working.
The question of including other medical specialties like pathology or palliative care was discussed. The Task Force agreed that medical and surgical specialists who are actively involved in the patient treatment are placed in a position to lead the tumour board or MDT meeting, and can undergo training in thoracic oncology. Because this may vary from country to country, a definite list of specialties was not made.
培训应该interprofessional multidisciplinary, post-specialty and part of continuing professional development leading to an additional post-specialty certificate attesting to an advanced expertise. The delivery of this curriculum should be through a modular training programme where modules can be followed separately, grouped into tracks or all followed together [12]。在此课程的情况下,例如,专家,胸外科医生可以根据需要遵循特定的模块或轨道。该专家将不需要有关胸腔手术的模块。当前的课程将用作定义强制性和可选模块作为特定专家的轨道的基础,作为工作队的下一步。此外,该课程也可能是交付模块化培训计划中社会间合作的基础。
The Thoracic Oncology HERMES Task Force proposes a detailed, interprofessional and multidisciplinary curriculum for training in thoracic oncology. This has been created using current concepts of medical education. We look forward to the development of structured educational programmes based on these curriculum recommendations within the ERS, by other professional societies, by local centres and through intersociety collaborations. We hope that this curriculum will help to define the scope of an advanced expertise in thoracic oncology. Well-trained thoracic oncology specialists working in the MDT will deliver the best quality of care to those suffering thoracic malignancies.
致谢
The members of the Thoracic Oncology HERMES Task Force are Alessandro Brunelli (Dept of Thoracic Surgery, St James's University Hospital, Leeds, UK), Anne-Marie C. Dingemans (Maastricht University Medical Centre, Pulmonology, Maastricht, the Netherlands), Enriqueta Felip (Hospital Univer. Vall d'Hebron, Barcelona, Spain), Mina Gaga (Athens Chest Hospital, 7th Respiratory Medicine Dept, Athens, Greece), Bogdan Dragos Grigoriu (University of Medicine and Pharmacy Iasi, Regional Institute of Oncology Iasi, Iasi, Romania), Georgia Hardavella (Dept of Respiratory Medicine, King's College Hospital, and Dept of Thoracic Medicine, University College London, London, UK), Rudolf M. Huber (Division of Respiratory Medicine and Thoracic Oncology, University of Munich, and Thoracic Oncology Centre Munich, Member of the German Centre for Lung Research (DZL CPC-M), Munich, Germany), Samuel Janes (University College London, Centre for Respiratory Research, London, UK), Gilbert Massard (Dept of Thoracic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France), Paul Martin Putora (Kantonsspital St Gallen, Dept of Radiation Oncology, St Gallen, Switzerland), Jean-Paul Sculier (Institut Jules Bordet, Intensive Care and Thoracic Oncology (ULB), Brussels, Belgium), Philipp A. Schnabel (Institut für Allgemeine und spezielle Pathologie, Universität des Saarlandes, Homburg/Saar, Germany), Sara Ramella (Campus Bio-Medico University, Radiation Oncology, Rome, Italy) and Dirk Van Raemdonck (Dept of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium).
Footnotes
利益冲突:J-L。Noël是欧洲呼吸社会的雇员。188bet官网地址可以与本文一起找到进一步的披露www.qdcxjkg.com
- ReceivedMay 27, 2016.
- Accepted2016年6月2日。
- Copyright ©ERS 2016