Defining Interstitial Lung Disease Education in Pulmonary Fellowship: A Mixed Methods Study.

Abstract

Patients with interstitial lung disease (ILD) often receive care from general pulmonologists because geographic and financial barriers limit access to specialized care centers. However, many graduating pulmonary fellows lack confidence in managing patients with ILD. Refining ILD education in pulmonary fellowship could address this gap, but what trainees must learn is not defined currently. What are the essential components of an ILD curriculum in a general pulmonary fellowship, including the skills required to care for patients with ILD and the conditions that fellows must learn to diagnose and manage? This exploratory, sequential mixed-methods study had 2 components. First, semistructured interviews were conducted with ILD experts who lead pulmonary fellowship programs to gather insights about ILD education. Second, an online 3-round modified Delphi survey was conducted. Forty-one individuals participated, including a combination of ILD experts, general pulmonologists, and clinician educators. Two survey rounds focused on identifying the skills and conditions essential for inclusion in an ILD curriculum in pulmonary fellowship. The a priori threshold for essential content was ≥ 75% of participants selecting a positive response. The third survey round assessed the expected level of practice independence for the diagnosis and management of the conditions meeting consensus for inclusion. Qualitative analysis of semistructured interviews generated 7 themes: diagnostic components, disease classification, treatment, care decisions, educational strategy, site of care, and the patient's illness journey. After the modified Delphi survey process, 48 skills and 29 conditions met consensus for inclusion in an ILD curriculum in pulmonary fellowship. Regarding the expected level of practice independence for each of the 29 conditions, participants expect a higher degree of independence with diagnosis than with management. This study provided a consensus-driven content outline to guide the development of an ILD curriculum within pulmonary fellowship training programs.