Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
time and relevant to their own training needs. Several techniques are
available: web-based data, interactive online modules, and virtual reality.
This is especially true within surgical training where the development of new
techniques constantly evolves. The rapid and constant evolution in oncology
knowledge’s makes it relevant for e-leaning process. E learning allows
trainees to apply and be assessed on the new information in a safe setting. In
addition, all contents can be discussed and debated around the medical world
without any limits. The level of trainees recall can be significantly increased
by e-learning techniques because it stimulates multi-sensory experiences. E
learning offers also large possibilities for decision making based on available
information and interactive decision-making process. Surgical e-learning
programs include the development of knowledge, technical skills, nontechnical
skills and decision-making process. The content of all the e-learning
modules should be relevant; best available, up to date and critically appraised
evidence should supports the information contained within the modules.
E-learning surgical programs should be based on an understanding of
educational principles, peer review resources associated to creativity. It could
be highly interactive. Immersive questions and answers for clinical setting
permit to trainee to progress through scenarios and makes the relevant
decisions and choices. Trainees have to evolve with their decisions and receive
feedback as to the choices they have made. These interactive models can be
created with text on the page or with simulators. E-learning modules should
be used as a complementary tool to traditional learning methods. Authors will
present their e-learning thoracic platform created at September 2013 : “Tenon
Thoracic Institute“ (www.tenon-thoracic-institute).This e-leaning thoracic
platform develops several e-learning tools: live from OR with interactive
discussion with faculty, round table with exerts, didactic session for young
trainees. All the aspects around thoracic pathology are treated: oncology,
surgery, anaesthesiology, radiology, etc. Authors will discuss the relevance of
such a platform, the lack of its content and future e-leaning projects.
Keywords: thoracic oncologic surgery, oncology, e-learning, education
SC30: NOVEL APPROACHES AND REGULATION IN SURGICAL EDUCATION
WEDNESDAY, DECEMBER 7, 2016 - 14:30-15:45
SC30.04 IMPACT OF WORKING TIME DIRECTIVES ON THORACIC
SURGICAL TRAINING: THE NORTH-AMERICAN EXPERIENCE
Claude Deschamps 1 , Ara Vaporciyan 2
1 Surgery, University of Vermont Medical Center, Burlington/United States of
America, 2 Thoracic and Cardiovascular Surgery, UT MD Anderson Cancer Center,
Houston/TX/United States of America
The following is in part the STS, TSDA and AATS combined response to ACGME
(collated and written up by Dr. Ara Vaporciyan) regarding the effect of Duty
hour regulations on resident education in Thoracic Surgery in North America.
A greater reliance on midlevel providers and physician extenders. This has
impacted the profession in terms of additional cost from their much higher
salaries, which are anywhere from 50% to 100% higher, but also a subtle but
steady transfer of bedside teaching previously focused on the trainee to
bedside teaching focused on the mid-level provider. Limited exposure to our
field. Our profession still fills the bulk of its training position from general
surgery graduates. Duty hour restrictions have contracted the ability of
those programs to provide elective rotations in thoracic and cardiac. Limited
exposure translates into limited interest and diminished applications. Quality
of Surgical and postoperative teaching. This is where we have felt the greatest
impact. We, like all surgical professions, have developed an increasing variety
of procedures necessitating expansion of our case log requirements. This puts
pressure on trainees to participate in every available case. Appropriate cases
are harder to find due to increasing case complexity and outcome reporting.
Therefore, the inability to scrub on just one or two of these cases can be
significant. While some large surgery programs have implemented float
pools to ensure that all cases provide someone a learning experience most CT
training programs are small and cannot implement that solution Even more
difficult to overcome is when a trainee misses a rare postoperative event. As
a high acuity specialty our patients will frequently develop rapid changes in
their condition which, if not recognized, can quickly become catastrophic.
Most occur in the immediate postoperative period at night. The use of
mid-level providers and other services to cover call in an effort to preserve a
trainee’s ability to do cases the next day prevents them from taking part in
the bedside assessment and management of these rare events. One solution
is to lengthen training to allow more opportunities but there is concurrent
pressure to reduce what is already one of the longest training paradigms (up
to 9 years for congenital surgeons without considering any time for research).
Alternatively simulation has been used but these are expensive and are not
easily implemented at all programs. Finally, issues of patient safety and
outcomes. While there is no clear study demonstrating documented impact
on patient safety there are many surveys of resident and faculty perceptions
of patient safety. The majority of these, especially in surgery, have shown
that the perception is that safety is compromised. The increased number
of handoffs, especially of high acuity cases, is frequently the target of that
perception. The subtle aspects of the intraoperative findings cannot always
be accurately communicated in a handoff. While patient safety data is not
conclusive there is data on worse outcomes in spinal and meningioma surgery
post implementation of duty hour regulations. These data may serve to
corroborate the perceived concerns.
Keywords: Education, duty hour regulation, working time directives
SESSION SC31: TOGETHER AGAINST LUNG CANCER
– A STRATEGY FOR SUCCESS IN THE 21ST CENTURY
WEDNESDAY, DECEMBER 7, 2016 - 14:30-15:45
SC31.01 THE ROLE OF SCIENTIFIC ORGANIZATIONS
Paul Bunn, Jr.
Department of Medical Oncology, University of Colorado Denver, Aurora/CO/United
States of America
The goal of scientific organizations is to facilitate progress in a specific area
through promotion of research, training and education. In some instances the
scientific area may be a single discipline such as medical, surgical or radiation
oncology, pathology, radiology and so on. In some instances the scientific
area may be a single geographic region such as Europe, North America or Asia.
Examples of such organizations would be the European Respiratory Society
(ERS), the American College of Radiology, the College of American Pathology
(CAP) and many, many others. In some instances the organization might
focus its efforts on training and research grants and in other instances the
organization might focus on education of the public and in public programs
such as prevention. In some instances the organization may conduct
research or may solely sponsor research to be done by others. Some scientific
organization chose to develop guidelines for clinical care. All of these efforts
are important and different organizations focus on different aspects of a
problem. In this presentation I will focus my attention on The International
Association for the Study of Lung Cancer (IASLC) since it is the sponsor of
the World Conferences on Lung Cancer and since is programs are dedicated
to reducing the world wide burden of thoracic cancers. Lung Cancer is the
leading cause of cancer death worldwide and the most preventable. When
the IASLC was organized in 1974 it was recognized not only that lung cancer
was the leading cancer killer but also that it would take an international
and multidisciplinary effort to make progress. The very international and
multidisciplinary nature of the IASLC are what set it apart from other
organizations. Many of the unique contributions of the IALSC rely on these
differentiating aspects. For example, the IASLC has contributed all the cases
and evaluation of the world wide lung cancer, mesothelioma and thymoma
TNM staging classifications. The IASLC Pathology committee has formulated
all of the changes to the pathologic classification of thoracic cancers. The
IASLC has worked with other organizations such as the College of American
pathology and Association of Molecular Pathology to develop guidelines
on molecular characterization of lung cancer. To enhance worldwide
collaboration and education the IASLC began the World Conferences on
Lung Cancer and rotated these conferences to different regions around the
world. Originally, these conferences were held every 3 years as progress was
slow but as research and research advances have quickened, the WCLCs are
ow held annually. In addition the IASLC sponsors regional meetings on a
routine basis including the European Lung Cancer Conference (ELCC), the
Latin America Lung Cancer Conference (LALCA), the Asia Pacific Lung cancer
conference and the Chicago Multidisciplinary Lung Cancer conference. The
IASLC also sponsors workshops on various timely topics such as a conference
on Small cell lung cancer held in 2015. To support its educational and research
missions the IASLC publishes a scientific journal entitled Journal of Thoracic
Oncology which has continually increased its circulation and impact factor.
More recently, the IALSC has reinstituted a weekly newsletter and has
published monographs on time issues such as ALK and PD-L1 testing. The
IASLC has sponsored research grants especially for junior faculty and fellows
to support and nurture their research careers. The IASLC has also sponsored
travel fellowship awards for junior investigators and for young faculty from
developing countries. The IASLC had worked with advocacy groups from
around the world to provide information and support to these groups and
to individuals and families afflicted by lung cancer. These efforts have led
to a sharing of efforts and to publications directed to patients and their
families. The IASLC’s tobacco committee has worked tirelessly to combat
the worldwide tobacco epidemic.References: Tan DS, Yom SS, Tsao MS, Pass
HI, Kelly K, Peled N, Yung RC, Wistuba II, Yatabe Y, Unger M, Mack PC, Wynes
MW, Mitsudomi T, Weder W, Yankelevitz D, Herbst RS, Gandara DR, Carbone
DP, Bunn PA Jr, Mok TS, Hirsch FRThe International Association for the Study
of Lung Cancer Consensus Statement on Optimizing Management of EGFR
Mutation-Positive Non-Small Cell Lung Cancer: Status in 2016. J Thorac
Oncol. 2016 Jul;11(7):946-63. doi: 10.1016/j.jtho.2016.05.008. Epub 2016 May
23. Review Bunn PA Jr, Minna JD, Augustyn A, et al. Small Cell Lung Cancer:
Can Recent Advances in Biology and Molecular Biology Be Translated into
Improved Outcomes?J Thorac Oncol. 2016 Apr;11(4):453-74. doi: 10.1016/j.
jtho.2016.01.012. Epub 2016 Jan 30. Review Goldstraw P, Chansky K, Crowley
J, Rami-Porta R, Asamura H, Eberhardt WE, Nicholson AG, Groome P, Mitchell
S74 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017