Society News

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. Here’s a preview of a recent popular clinical discussion:  

Robert Herman, MD, wrote in “Rectal lesion”:

A 42-year-old healthy female was seen by me for symptoms of non-ulcer dyspepsia that was unresponsive to H2 Blockers and for assessment for screening colonoscopy. Her father had developed colon cancer at the age of 50. She denied changes in bowel habits, pattern, rectal bleeding, or melena. An EGD revealed a medium sized hiatal hernia and LA Grade B esophagitis that responded well to an OTC PPI qd.

A colonoscopy was performed and revealed a 4-cm anterior rectal “bulge” just above the hemorrhoidal plexus, appearing somewhat firm and mobile on probing the lesion with a closed biopsy forceps, and a 1 cm sessile IC valve adenomatous polyp.

And then the endoscopic medical assistant made a comment that changed everything. Read the full case discussion: https://community.gastro.org/posts/25568.
 

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. Here’s a preview of a recent popular clinical discussion:  

Robert Herman, MD, wrote in “Rectal lesion”:

A 42-year-old healthy female was seen by me for symptoms of non-ulcer dyspepsia that was unresponsive to H2 Blockers and for assessment for screening colonoscopy. Her father had developed colon cancer at the age of 50. She denied changes in bowel habits, pattern, rectal bleeding, or melena. An EGD revealed a medium sized hiatal hernia and LA Grade B esophagitis that responded well to an OTC PPI qd.

A colonoscopy was performed and revealed a 4-cm anterior rectal “bulge” just above the hemorrhoidal plexus, appearing somewhat firm and mobile on probing the lesion with a closed biopsy forceps, and a 1 cm sessile IC valve adenomatous polyp.

And then the endoscopic medical assistant made a comment that changed everything. Read the full case discussion: https://community.gastro.org/posts/25568.
 

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. Here’s a preview of a recent popular clinical discussion:  

Robert Herman, MD, wrote in “Rectal lesion”:

A 42-year-old healthy female was seen by me for symptoms of non-ulcer dyspepsia that was unresponsive to H2 Blockers and for assessment for screening colonoscopy. Her father had developed colon cancer at the age of 50. She denied changes in bowel habits, pattern, rectal bleeding, or melena. An EGD revealed a medium sized hiatal hernia and LA Grade B esophagitis that responded well to an OTC PPI qd.

A colonoscopy was performed and revealed a 4-cm anterior rectal “bulge” just above the hemorrhoidal plexus, appearing somewhat firm and mobile on probing the lesion with a closed biopsy forceps, and a 1 cm sessile IC valve adenomatous polyp.

And then the endoscopic medical assistant made a comment that changed everything. Read the full case discussion: https://community.gastro.org/posts/25568.
 

Patients with cirrhosis, or permanent liver damage, are at higher risk for coagulation disorders, which impact your body’s ability to control blood clotting. This puts cirrhosis patients at increased risk of morbidity and mortality when undergoing diagnostic or therapeutic invasive procedures. AGA has released new clinical guidelines to change how you identify and treat coagulation disorders in patients with cirrhosis. In this new guidance, AGA recommends against the use of extensive preprocedural testing to estimate clotting in patients with cirrhosis. These guidelines, which were developed after a detailed review of available literature, are published in Gastroenterology, AGA’s official journal.

Key guideline recommendations:

• Extensive preprocedural testing, including measurements of prothrombin time/international normalized ratio or platelet count, should not routinely be performed in patients with stable cirrhosis undergoing common GI procedures.
• Blood products, including fresh frozen plasma or platelet transfusion, should not routinely be used for bleeding prophylaxis in patients with stable cirrhosis undergoing common GI procedures.
• Standard pharmacologic venous thromboembolism prophylaxis should be given to hospitalized patients with cirrhosis like other medical patients.
• Anticoagulation should be used to treat acute or subacute nontumoral portal vein thrombosis in patients with cirrhosis to improve patient outcomes.

Learn more in the AGA GI Patient Center. Read the AGA Clinical Practice Guidelines on the Management of Coagulation Disorders in Patients with Cirrhosis to review the complete recommendations.

Patients with cirrhosis, or permanent liver damage, are at higher risk for coagulation disorders, which impact your body’s ability to control blood clotting. This puts cirrhosis patients at increased risk of morbidity and mortality when undergoing diagnostic or therapeutic invasive procedures. AGA has released new clinical guidelines to change how you identify and treat coagulation disorders in patients with cirrhosis. In this new guidance, AGA recommends against the use of extensive preprocedural testing to estimate clotting in patients with cirrhosis. These guidelines, which were developed after a detailed review of available literature, are published in Gastroenterology, AGA’s official journal.

Key guideline recommendations:

• Extensive preprocedural testing, including measurements of prothrombin time/international normalized ratio or platelet count, should not routinely be performed in patients with stable cirrhosis undergoing common GI procedures.
• Blood products, including fresh frozen plasma or platelet transfusion, should not routinely be used for bleeding prophylaxis in patients with stable cirrhosis undergoing common GI procedures.
• Standard pharmacologic venous thromboembolism prophylaxis should be given to hospitalized patients with cirrhosis like other medical patients.
• Anticoagulation should be used to treat acute or subacute nontumoral portal vein thrombosis in patients with cirrhosis to improve patient outcomes.

Learn more in the AGA GI Patient Center. Read the AGA Clinical Practice Guidelines on the Management of Coagulation Disorders in Patients with Cirrhosis to review the complete recommendations.

Patients with cirrhosis, or permanent liver damage, are at higher risk for coagulation disorders, which impact your body’s ability to control blood clotting. This puts cirrhosis patients at increased risk of morbidity and mortality when undergoing diagnostic or therapeutic invasive procedures. AGA has released new clinical guidelines to change how you identify and treat coagulation disorders in patients with cirrhosis. In this new guidance, AGA recommends against the use of extensive preprocedural testing to estimate clotting in patients with cirrhosis. These guidelines, which were developed after a detailed review of available literature, are published in Gastroenterology, AGA’s official journal.

Key guideline recommendations:

• Extensive preprocedural testing, including measurements of prothrombin time/international normalized ratio or platelet count, should not routinely be performed in patients with stable cirrhosis undergoing common GI procedures.
• Blood products, including fresh frozen plasma or platelet transfusion, should not routinely be used for bleeding prophylaxis in patients with stable cirrhosis undergoing common GI procedures.
• Standard pharmacologic venous thromboembolism prophylaxis should be given to hospitalized patients with cirrhosis like other medical patients.
• Anticoagulation should be used to treat acute or subacute nontumoral portal vein thrombosis in patients with cirrhosis to improve patient outcomes.

Learn more in the AGA GI Patient Center. Read the AGA Clinical Practice Guidelines on the Management of Coagulation Disorders in Patients with Cirrhosis to review the complete recommendations.

2022 Medicare payment rules contain both good and bad news for GI. First the bad news: GIs and other specialties face millions of dollars in cuts as Medicare finalized a 3.71% cut to the Physician Fee Schedule conversion factor, which could increase to near 9% if Congress doesn’t act.

Here are highlights from the 2022 Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Department (HOPD)/Ambulatory Surgery Center (ASC) final rules.

Good news

• Telehealth reimbursement continues through December 2023.
• Medicare coverage changes from the Removing Barriers to Colorectal Cancer Screening Act were finalized and coinsurance reduction will start Jan. 1, 2022, with full phase out by 2030.

Bad news

• A 3.71% cut to MPFS 2022 conversion factor, which could result in a up to 9% cut to our practices. Email your lawmaker now.
• HOPD and ASC conversion factors will increase 2% for those that meet applicable quality reporting requirements.
• New MPFS payments for peroral endoscopic myotomy (POEM) and some capsule endoscopy CPT codes not as high as expected.

2022 Medicare payment rules contain both good and bad news for GI. First the bad news: GIs and other specialties face millions of dollars in cuts as Medicare finalized a 3.71% cut to the Physician Fee Schedule conversion factor, which could increase to near 9% if Congress doesn’t act.

Here are highlights from the 2022 Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Department (HOPD)/Ambulatory Surgery Center (ASC) final rules.

Good news

• Telehealth reimbursement continues through December 2023.
• Medicare coverage changes from the Removing Barriers to Colorectal Cancer Screening Act were finalized and coinsurance reduction will start Jan. 1, 2022, with full phase out by 2030.

Bad news

• A 3.71% cut to MPFS 2022 conversion factor, which could result in a up to 9% cut to our practices. Email your lawmaker now.
• HOPD and ASC conversion factors will increase 2% for those that meet applicable quality reporting requirements.
• New MPFS payments for peroral endoscopic myotomy (POEM) and some capsule endoscopy CPT codes not as high as expected.

2022 Medicare payment rules contain both good and bad news for GI. First the bad news: GIs and other specialties face millions of dollars in cuts as Medicare finalized a 3.71% cut to the Physician Fee Schedule conversion factor, which could increase to near 9% if Congress doesn’t act.

Here are highlights from the 2022 Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Department (HOPD)/Ambulatory Surgery Center (ASC) final rules.

Good news

• Telehealth reimbursement continues through December 2023.
• Medicare coverage changes from the Removing Barriers to Colorectal Cancer Screening Act were finalized and coinsurance reduction will start Jan. 1, 2022, with full phase out by 2030.

Bad news

• A 3.71% cut to MPFS 2022 conversion factor, which could result in a up to 9% cut to our practices. Email your lawmaker now.
• HOPD and ASC conversion factors will increase 2% for those that meet applicable quality reporting requirements.
• New MPFS payments for peroral endoscopic myotomy (POEM) and some capsule endoscopy CPT codes not as high as expected.

Creating a stronger voice for CHEST members in pulmonary, critical care, and sleep medicine, CHEST works to provide opportunities for members to serve as expert sources for both mainstream and trade media.

Below are a few highlights of media coverage from the past few months that work to expand awareness of CHEST and to promote the expertise of CHEST members in the media.
 

The New York Times covers the Philips recall

In August, a New York Times article published quoting incoming CHEST President, David Schulman, MD, MPH, FCCP. The article covered the recent Philips recall and its impact on the COVID-19 pandemic.

Dr. Schulman is quoted saying, “Because the number of people coming into the hospital with severe respiratory symptoms has increased as a result of COVID-19, the demand for these devices has also increased, which is problematic since available supply has decreased as a result of the Philips recall.”

The full article, Breathing Machine Recall Over Possible Cancer Risk Leaves Millions Scrambling for Substitutes, can be found on the New York Times website.
 

Technical expert panel on coverage determinations

Peter Gay, MD, FCCP, was quoted in an article by McKnight’s Long-Term Care News on the recent technical expert panel recommendations for national coverage determinations for optimal noninvasive ventilation.

“Centers for Medicare & Medicaid Services was wanting rigorous scientific support necessary to clarify the ‘reasonable and necessary’ role of these new mechanical therapeutic modalities where there was none in order to move forward,” said Dr. Gay. “What we have done is create a pathway to simplify the maze of regulation and perhaps most importantly, remove the obstacles that currently exist.”

The full article, Panel on Non-Invasive Ventilation Seeks to Simplify ‘Maze’ of Regulation for Device Coverage, can be found on the McKnight’s Long-Term Care News website.
 

Asthma and HRT

Originally appearing in HealthDay, U.S. News and World Report covered a recent journal CHEST^® publication Hormone Replacement Therapy and Development of New Asthma by Erik Soeren Halvard Hansen, MD, et al.

The study included about 34,500 women who were diagnosed with asthma between 1995 and 2018, when they were 40 to 65 years of age. Each was then compared with 10 asthma-free women.

Based on that comparison, HRT use was associated with a 63% higher risk for developing asthma, according to the study.

The full article, HRT Could Raise Odds for Asthma, can be found on the U.S. News & World Report website.
 

Pediatric ICU admission and COVID-19

Healio Pulmonology covered a recent journal CHEST publication, Changes in Pediatric ICU Utilization and Clinical Trends During the Coronavirus Pandemic, by Janine E. Zee-Cheng, MD, et al.

“Severe infections, traumatic injuries, perioperative conditions and acute exacerbations of chronic illnesses such as asthma and diabetes are among the most common causes of admission to a pediatric ICU; thus, the epidemiology of pediatric critical illness was likely sensitive to the indirect effects of COVID-19,” Janine E. Zee-Cheng, MD, adjunct clinical assistant professor of pediatrics in the department of pediatrics at Indiana University School of Medicine, Indianapolis, and colleagues wrote.

The full article, Pediatric ICU admissions significantly decreased during COVID-19 pandemic, can be found on the Healio website.
 

CHEST news

CHEST also recently issued a handful of statements and press releases on a variety of topics including the spread of misinformation, support of mandatory vaccinations for health care workers, and a statement advocating for broader coverage of supplemental oxygen use.

For all recent CHEST News, including these statements, visit the CHEST Newsroom on the CHEST website and follow the hashtag #CHESTNews on Twitter.

If you have been included in a recent news article and would like it to be featured, send the coverage to [email protected].

Creating a stronger voice for CHEST members in pulmonary, critical care, and sleep medicine, CHEST works to provide opportunities for members to serve as expert sources for both mainstream and trade media.

Below are a few highlights of media coverage from the past few months that work to expand awareness of CHEST and to promote the expertise of CHEST members in the media.
 

The New York Times covers the Philips recall

In August, a New York Times article published quoting incoming CHEST President, David Schulman, MD, MPH, FCCP. The article covered the recent Philips recall and its impact on the COVID-19 pandemic.

Dr. Schulman is quoted saying, “Because the number of people coming into the hospital with severe respiratory symptoms has increased as a result of COVID-19, the demand for these devices has also increased, which is problematic since available supply has decreased as a result of the Philips recall.”

The full article, Breathing Machine Recall Over Possible Cancer Risk Leaves Millions Scrambling for Substitutes, can be found on the New York Times website.
 

Technical expert panel on coverage determinations

Peter Gay, MD, FCCP, was quoted in an article by McKnight’s Long-Term Care News on the recent technical expert panel recommendations for national coverage determinations for optimal noninvasive ventilation.

“Centers for Medicare & Medicaid Services was wanting rigorous scientific support necessary to clarify the ‘reasonable and necessary’ role of these new mechanical therapeutic modalities where there was none in order to move forward,” said Dr. Gay. “What we have done is create a pathway to simplify the maze of regulation and perhaps most importantly, remove the obstacles that currently exist.”

The full article, Panel on Non-Invasive Ventilation Seeks to Simplify ‘Maze’ of Regulation for Device Coverage, can be found on the McKnight’s Long-Term Care News website.
 

Asthma and HRT

Originally appearing in HealthDay, U.S. News and World Report covered a recent journal CHEST^® publication Hormone Replacement Therapy and Development of New Asthma by Erik Soeren Halvard Hansen, MD, et al.

The study included about 34,500 women who were diagnosed with asthma between 1995 and 2018, when they were 40 to 65 years of age. Each was then compared with 10 asthma-free women.

Based on that comparison, HRT use was associated with a 63% higher risk for developing asthma, according to the study.

The full article, HRT Could Raise Odds for Asthma, can be found on the U.S. News & World Report website.
 

Pediatric ICU admission and COVID-19

Healio Pulmonology covered a recent journal CHEST publication, Changes in Pediatric ICU Utilization and Clinical Trends During the Coronavirus Pandemic, by Janine E. Zee-Cheng, MD, et al.

“Severe infections, traumatic injuries, perioperative conditions and acute exacerbations of chronic illnesses such as asthma and diabetes are among the most common causes of admission to a pediatric ICU; thus, the epidemiology of pediatric critical illness was likely sensitive to the indirect effects of COVID-19,” Janine E. Zee-Cheng, MD, adjunct clinical assistant professor of pediatrics in the department of pediatrics at Indiana University School of Medicine, Indianapolis, and colleagues wrote.

The full article, Pediatric ICU admissions significantly decreased during COVID-19 pandemic, can be found on the Healio website.
 

CHEST news

CHEST also recently issued a handful of statements and press releases on a variety of topics including the spread of misinformation, support of mandatory vaccinations for health care workers, and a statement advocating for broader coverage of supplemental oxygen use.

For all recent CHEST News, including these statements, visit the CHEST Newsroom on the CHEST website and follow the hashtag #CHESTNews on Twitter.

If you have been included in a recent news article and would like it to be featured, send the coverage to [email protected].

Creating a stronger voice for CHEST members in pulmonary, critical care, and sleep medicine, CHEST works to provide opportunities for members to serve as expert sources for both mainstream and trade media.

Below are a few highlights of media coverage from the past few months that work to expand awareness of CHEST and to promote the expertise of CHEST members in the media.
 

The New York Times covers the Philips recall

In August, a New York Times article published quoting incoming CHEST President, David Schulman, MD, MPH, FCCP. The article covered the recent Philips recall and its impact on the COVID-19 pandemic.

Dr. Schulman is quoted saying, “Because the number of people coming into the hospital with severe respiratory symptoms has increased as a result of COVID-19, the demand for these devices has also increased, which is problematic since available supply has decreased as a result of the Philips recall.”

The full article, Breathing Machine Recall Over Possible Cancer Risk Leaves Millions Scrambling for Substitutes, can be found on the New York Times website.
 

Technical expert panel on coverage determinations

Peter Gay, MD, FCCP, was quoted in an article by McKnight’s Long-Term Care News on the recent technical expert panel recommendations for national coverage determinations for optimal noninvasive ventilation.

“Centers for Medicare & Medicaid Services was wanting rigorous scientific support necessary to clarify the ‘reasonable and necessary’ role of these new mechanical therapeutic modalities where there was none in order to move forward,” said Dr. Gay. “What we have done is create a pathway to simplify the maze of regulation and perhaps most importantly, remove the obstacles that currently exist.”

The full article, Panel on Non-Invasive Ventilation Seeks to Simplify ‘Maze’ of Regulation for Device Coverage, can be found on the McKnight’s Long-Term Care News website.
 

Asthma and HRT

Originally appearing in HealthDay, U.S. News and World Report covered a recent journal CHEST^® publication Hormone Replacement Therapy and Development of New Asthma by Erik Soeren Halvard Hansen, MD, et al.

The study included about 34,500 women who were diagnosed with asthma between 1995 and 2018, when they were 40 to 65 years of age. Each was then compared with 10 asthma-free women.

Based on that comparison, HRT use was associated with a 63% higher risk for developing asthma, according to the study.

The full article, HRT Could Raise Odds for Asthma, can be found on the U.S. News & World Report website.
 

Pediatric ICU admission and COVID-19

Healio Pulmonology covered a recent journal CHEST publication, Changes in Pediatric ICU Utilization and Clinical Trends During the Coronavirus Pandemic, by Janine E. Zee-Cheng, MD, et al.

“Severe infections, traumatic injuries, perioperative conditions and acute exacerbations of chronic illnesses such as asthma and diabetes are among the most common causes of admission to a pediatric ICU; thus, the epidemiology of pediatric critical illness was likely sensitive to the indirect effects of COVID-19,” Janine E. Zee-Cheng, MD, adjunct clinical assistant professor of pediatrics in the department of pediatrics at Indiana University School of Medicine, Indianapolis, and colleagues wrote.

The full article, Pediatric ICU admissions significantly decreased during COVID-19 pandemic, can be found on the Healio website.
 

CHEST news

CHEST also recently issued a handful of statements and press releases on a variety of topics including the spread of misinformation, support of mandatory vaccinations for health care workers, and a statement advocating for broader coverage of supplemental oxygen use.

For all recent CHEST News, including these statements, visit the CHEST Newsroom on the CHEST website and follow the hashtag #CHESTNews on Twitter.

If you have been included in a recent news article and would like it to be featured, send the coverage to [email protected].

(This post is part of Our Life as a Fellow blog post series. This series includes “fellow life lessons” from current trainees in leadership with CHEST.)

Finding your passion in fellowship is an integral part of career development and has a profound impact on a young professional’s personal satisfaction. This can be a difficult task, but it can be accomplished by finding a mentor, thinking about long-term career goals, and considering what re-energizes you. Entering fellowship, some may have a preconceived idea of who they would like to be upon completion of training: An asthma specialist, a physician-scientist, a critical care junkie, etc. For most of us, fellowship is a black box of opportunity with endless paths and permutations. It can be difficult to navigate this landscape, as the path may meander and a few initial interests may develop into true passions.

During my fellowship, I have been fortunate to have had many great teachers and experiences caring for patients with pulmonary hypertension, my current primary focus. Here are a few steps I have taken in pursuit of finding my passion over the past several years of post-graduate medical education. ***Disclaimer: I am still a work in progress.***

First, find a mentor. For me it was easy – I remember interviewing for fellowship with my mentor and thinking: “That is who I want to be.” I think this is hugely important. Use the insights, mistakes, and successes of someone you admire (from near or far) to help guide you. Initially, while getting to know my mentor, it was more comfortable to follow from a safe distance without making an official commitment. This was a slow process that allowed me to explore multiple clinical and research interests simultaneously. Once your mind is set, stating your professional interests in a concise way helps you and your mentor define and differentiate hobbies from passions. The practice of medicine is still very much an apprenticeship, so having someone to act as a sounding board remains important. Mentorship is also critical for networking, which is important for professional growth and life beyond fellowship. Our community is small, and “people know people.” What happens if you can’t find a perfect mentor? Don’t worry! Try out as many mentors as you can find. You can learn from every conversation and relationship. Sometimes the path taken is just as important as the destination.

Second, think about your 5- or 10-year plan. Ultimately, when training is over, we will graduate from fellowship and be released into the wild. The skills we have obtained in training are going to be the foundation for the rest of our careers. Where would you like to be a few years post-training? In a lab? Private practice? Rural medicine? Teaching? Does the energy you are spending in fellowship to develop your passion extend beyond fellowship? Part of the excitement of pursuing a passion is envisioning how it may develop over the period of coming years. I envision honing my skills as a master general pulmonary clinician and then narrowing my focus to create a pulmonary hypertension care center of excellence. I think these are important points to consider while you have the protected headspace of fellowship to experiment and explore, and while you are not constrained by contractual obligations.

Third, think about what personally and professionally energizes you. Especially in the context of an ongoing global pandemic, burnout and physician dissatisfaction are at an all-time high. Acknowledge that your job is tough, and try to identify the things that will keep the engine running. This sounds straightforward, but you have to decide what recharges you and acknowledge those things that don’t. The importance of determining things that energize me did not occur to me until I started searching for my first job. This forced me to make a list of things that contributed to my happiness and dissatisfaction. Most future employers are skilled at asking about these qualities. A happy employee is productive and effective at his or her job!

If you are in training, take some time to get creative and answer the questions above. Doodle, make lists, or journal—find a moment to reflect on your hard work and on the promise of your future.
 

Kevin Swiatek, DO

Dr. Swiatek is a third-year Chief Fellow in the Division of Pulmonary and Critical Care Medicine at Virginia Commonwealth University in Richmond, Virginia. Dr. Swiatek is a member of the CHEST Trainee Work Group. His clinical interests include general pulmonary medicine, care of patients with pulmonary hypertension, and using point-of-care ultrasound (POCUS) as a diagnostic tool in the medical intensive care unit. His scholarly interests include implementation of fellowship medical education, teaching POCUS, and clinical and diagnostic assessment of patients with pulmonary hypertension.

Reprinted from Thought Leader Blog. August 23, 2021. www.chestnet.org.

(This post is part of Our Life as a Fellow blog post series. This series includes “fellow life lessons” from current trainees in leadership with CHEST.)

Finding your passion in fellowship is an integral part of career development and has a profound impact on a young professional’s personal satisfaction. This can be a difficult task, but it can be accomplished by finding a mentor, thinking about long-term career goals, and considering what re-energizes you. Entering fellowship, some may have a preconceived idea of who they would like to be upon completion of training: An asthma specialist, a physician-scientist, a critical care junkie, etc. For most of us, fellowship is a black box of opportunity with endless paths and permutations. It can be difficult to navigate this landscape, as the path may meander and a few initial interests may develop into true passions.

During my fellowship, I have been fortunate to have had many great teachers and experiences caring for patients with pulmonary hypertension, my current primary focus. Here are a few steps I have taken in pursuit of finding my passion over the past several years of post-graduate medical education. ***Disclaimer: I am still a work in progress.***

First, find a mentor. For me it was easy – I remember interviewing for fellowship with my mentor and thinking: “That is who I want to be.” I think this is hugely important. Use the insights, mistakes, and successes of someone you admire (from near or far) to help guide you. Initially, while getting to know my mentor, it was more comfortable to follow from a safe distance without making an official commitment. This was a slow process that allowed me to explore multiple clinical and research interests simultaneously. Once your mind is set, stating your professional interests in a concise way helps you and your mentor define and differentiate hobbies from passions. The practice of medicine is still very much an apprenticeship, so having someone to act as a sounding board remains important. Mentorship is also critical for networking, which is important for professional growth and life beyond fellowship. Our community is small, and “people know people.” What happens if you can’t find a perfect mentor? Don’t worry! Try out as many mentors as you can find. You can learn from every conversation and relationship. Sometimes the path taken is just as important as the destination.

Second, think about your 5- or 10-year plan. Ultimately, when training is over, we will graduate from fellowship and be released into the wild. The skills we have obtained in training are going to be the foundation for the rest of our careers. Where would you like to be a few years post-training? In a lab? Private practice? Rural medicine? Teaching? Does the energy you are spending in fellowship to develop your passion extend beyond fellowship? Part of the excitement of pursuing a passion is envisioning how it may develop over the period of coming years. I envision honing my skills as a master general pulmonary clinician and then narrowing my focus to create a pulmonary hypertension care center of excellence. I think these are important points to consider while you have the protected headspace of fellowship to experiment and explore, and while you are not constrained by contractual obligations.

Third, think about what personally and professionally energizes you. Especially in the context of an ongoing global pandemic, burnout and physician dissatisfaction are at an all-time high. Acknowledge that your job is tough, and try to identify the things that will keep the engine running. This sounds straightforward, but you have to decide what recharges you and acknowledge those things that don’t. The importance of determining things that energize me did not occur to me until I started searching for my first job. This forced me to make a list of things that contributed to my happiness and dissatisfaction. Most future employers are skilled at asking about these qualities. A happy employee is productive and effective at his or her job!

If you are in training, take some time to get creative and answer the questions above. Doodle, make lists, or journal—find a moment to reflect on your hard work and on the promise of your future.
 

Kevin Swiatek, DO

Dr. Swiatek is a third-year Chief Fellow in the Division of Pulmonary and Critical Care Medicine at Virginia Commonwealth University in Richmond, Virginia. Dr. Swiatek is a member of the CHEST Trainee Work Group. His clinical interests include general pulmonary medicine, care of patients with pulmonary hypertension, and using point-of-care ultrasound (POCUS) as a diagnostic tool in the medical intensive care unit. His scholarly interests include implementation of fellowship medical education, teaching POCUS, and clinical and diagnostic assessment of patients with pulmonary hypertension.

Reprinted from Thought Leader Blog. August 23, 2021. www.chestnet.org.

(This post is part of Our Life as a Fellow blog post series. This series includes “fellow life lessons” from current trainees in leadership with CHEST.)

Finding your passion in fellowship is an integral part of career development and has a profound impact on a young professional’s personal satisfaction. This can be a difficult task, but it can be accomplished by finding a mentor, thinking about long-term career goals, and considering what re-energizes you. Entering fellowship, some may have a preconceived idea of who they would like to be upon completion of training: An asthma specialist, a physician-scientist, a critical care junkie, etc. For most of us, fellowship is a black box of opportunity with endless paths and permutations. It can be difficult to navigate this landscape, as the path may meander and a few initial interests may develop into true passions.

During my fellowship, I have been fortunate to have had many great teachers and experiences caring for patients with pulmonary hypertension, my current primary focus. Here are a few steps I have taken in pursuit of finding my passion over the past several years of post-graduate medical education. ***Disclaimer: I am still a work in progress.***

First, find a mentor. For me it was easy – I remember interviewing for fellowship with my mentor and thinking: “That is who I want to be.” I think this is hugely important. Use the insights, mistakes, and successes of someone you admire (from near or far) to help guide you. Initially, while getting to know my mentor, it was more comfortable to follow from a safe distance without making an official commitment. This was a slow process that allowed me to explore multiple clinical and research interests simultaneously. Once your mind is set, stating your professional interests in a concise way helps you and your mentor define and differentiate hobbies from passions. The practice of medicine is still very much an apprenticeship, so having someone to act as a sounding board remains important. Mentorship is also critical for networking, which is important for professional growth and life beyond fellowship. Our community is small, and “people know people.” What happens if you can’t find a perfect mentor? Don’t worry! Try out as many mentors as you can find. You can learn from every conversation and relationship. Sometimes the path taken is just as important as the destination.

Second, think about your 5- or 10-year plan. Ultimately, when training is over, we will graduate from fellowship and be released into the wild. The skills we have obtained in training are going to be the foundation for the rest of our careers. Where would you like to be a few years post-training? In a lab? Private practice? Rural medicine? Teaching? Does the energy you are spending in fellowship to develop your passion extend beyond fellowship? Part of the excitement of pursuing a passion is envisioning how it may develop over the period of coming years. I envision honing my skills as a master general pulmonary clinician and then narrowing my focus to create a pulmonary hypertension care center of excellence. I think these are important points to consider while you have the protected headspace of fellowship to experiment and explore, and while you are not constrained by contractual obligations.

Third, think about what personally and professionally energizes you. Especially in the context of an ongoing global pandemic, burnout and physician dissatisfaction are at an all-time high. Acknowledge that your job is tough, and try to identify the things that will keep the engine running. This sounds straightforward, but you have to decide what recharges you and acknowledge those things that don’t. The importance of determining things that energize me did not occur to me until I started searching for my first job. This forced me to make a list of things that contributed to my happiness and dissatisfaction. Most future employers are skilled at asking about these qualities. A happy employee is productive and effective at his or her job!

If you are in training, take some time to get creative and answer the questions above. Doodle, make lists, or journal—find a moment to reflect on your hard work and on the promise of your future.
 

Kevin Swiatek, DO

Dr. Swiatek is a third-year Chief Fellow in the Division of Pulmonary and Critical Care Medicine at Virginia Commonwealth University in Richmond, Virginia. Dr. Swiatek is a member of the CHEST Trainee Work Group. His clinical interests include general pulmonary medicine, care of patients with pulmonary hypertension, and using point-of-care ultrasound (POCUS) as a diagnostic tool in the medical intensive care unit. His scholarly interests include implementation of fellowship medical education, teaching POCUS, and clinical and diagnostic assessment of patients with pulmonary hypertension.

Reprinted from Thought Leader Blog. August 23, 2021. www.chestnet.org.

Thanksgiving has long been my favorite holiday: a chance to reconnect with family and friends as well as time for reflection, gratitude, and hope. While Thanksgiving 2020 (sadly) was spent eating takeout turkey on the couch due to the pandemic, I am hopeful that Thanksgiving 2021 will for most of us bring a return to the holiday traditions that sustain us.

In this month’s issue of GIHN, we highlight several important studies impacting frontline clinical practice. Relevant to patients with liver disease, we highlight work evaluating the potential supra-additive effects of alcohol intake and obesity in impacting cirrhosis incidence and assessing the comparative performance of non-invasive screening tests in detecting NASH-related fibrosis. Another study of note, relevant to clinical management of GERD, suggests that combinations of abnormal pH-impedance monitoring metrics may predict PPI nonresponders better than individual metrics and could be used to identify patients more likely to respond to invasive GERD management.

We also wish to acknowledge in this issue the outstanding work that AGA and its fellow societies do on behalf of the gastroenterology community in developing and harmonizing ACGME Reporting Milestones for GI and Transplant Hepatology fellowship programs to assist with trainee assessment. Our fellowship trainees represent the future of our profession, and it is of critical importance that we train competent, compassionate professionals who will provide outstanding clinical care to our patients. Kudos to the team, including Dr. Brijen Shah, GI & Hepatology News associate editor Dr. Janice Jou, and others, for their hard work on Milestones 2.0!

Megan A. Adams, MD, JD, MSc
Editor in Chief

Thanksgiving has long been my favorite holiday: a chance to reconnect with family and friends as well as time for reflection, gratitude, and hope. While Thanksgiving 2020 (sadly) was spent eating takeout turkey on the couch due to the pandemic, I am hopeful that Thanksgiving 2021 will for most of us bring a return to the holiday traditions that sustain us.

In this month’s issue of GIHN, we highlight several important studies impacting frontline clinical practice. Relevant to patients with liver disease, we highlight work evaluating the potential supra-additive effects of alcohol intake and obesity in impacting cirrhosis incidence and assessing the comparative performance of non-invasive screening tests in detecting NASH-related fibrosis. Another study of note, relevant to clinical management of GERD, suggests that combinations of abnormal pH-impedance monitoring metrics may predict PPI nonresponders better than individual metrics and could be used to identify patients more likely to respond to invasive GERD management.

We also wish to acknowledge in this issue the outstanding work that AGA and its fellow societies do on behalf of the gastroenterology community in developing and harmonizing ACGME Reporting Milestones for GI and Transplant Hepatology fellowship programs to assist with trainee assessment. Our fellowship trainees represent the future of our profession, and it is of critical importance that we train competent, compassionate professionals who will provide outstanding clinical care to our patients. Kudos to the team, including Dr. Brijen Shah, GI & Hepatology News associate editor Dr. Janice Jou, and others, for their hard work on Milestones 2.0!

Megan A. Adams, MD, JD, MSc
Editor in Chief

Thanksgiving has long been my favorite holiday: a chance to reconnect with family and friends as well as time for reflection, gratitude, and hope. While Thanksgiving 2020 (sadly) was spent eating takeout turkey on the couch due to the pandemic, I am hopeful that Thanksgiving 2021 will for most of us bring a return to the holiday traditions that sustain us.

In this month’s issue of GIHN, we highlight several important studies impacting frontline clinical practice. Relevant to patients with liver disease, we highlight work evaluating the potential supra-additive effects of alcohol intake and obesity in impacting cirrhosis incidence and assessing the comparative performance of non-invasive screening tests in detecting NASH-related fibrosis. Another study of note, relevant to clinical management of GERD, suggests that combinations of abnormal pH-impedance monitoring metrics may predict PPI nonresponders better than individual metrics and could be used to identify patients more likely to respond to invasive GERD management.

We also wish to acknowledge in this issue the outstanding work that AGA and its fellow societies do on behalf of the gastroenterology community in developing and harmonizing ACGME Reporting Milestones for GI and Transplant Hepatology fellowship programs to assist with trainee assessment. Our fellowship trainees represent the future of our profession, and it is of critical importance that we train competent, compassionate professionals who will provide outstanding clinical care to our patients. Kudos to the team, including Dr. Brijen Shah, GI & Hepatology News associate editor Dr. Janice Jou, and others, for their hard work on Milestones 2.0!

Megan A. Adams, MD, JD, MSc
Editor in Chief

As COVID-19 cases rise in the United States due to the Delta variant, there is renewed concern about infection and transmission of SARS-CoV-2 during endoscopy. In May 2021, AGA released updated recommendations on preprocedure testing post vaccination in the setting of ongoing population-wide vaccination programs for the prevention of COVID-19–related morbidity. In vaccinated individuals, breakthrough infections occurred very infrequently. Weighing the evidence demonstrating extremely low rates of rates of infection and transmission with vaccination and PPE, and considering the downsides of routine testing (burden, cost, false test results, increased disparities), AGA made a conditional recommendation against routine preprocedure testing for elective cases. The highly contagious Delta variant has now emerged as the predominant SARS-CoV2 virus in the U.S. and some data suggests that it may cause more severe illness than previous strains.  While more breakthrough infections may develop in fully vaccinated individuals, the greatest risk of infection, transmission and hospitalizations is among those who are unvaccinated.

• AGA suggests against reinstituting routine preprocedure testing prior to elective endoscopy. The downsides (delays in patient care, burden, inaccurate results) outweigh potential benefits. Infection and transmission of SARS-CoV-2 from asymptomatic individuals is rare especially among vaccinated health care workers using personal protective equipment (PPE), even with the emergence of the Delta variant.
• If PPE is available, AGA recommends using N95 for upper endoscopy and suggests using N95 or surgical masks for lower endoscopy (acknowledging that upper endoscopy is more aerosolizing than lower endoscopy) and continuation of elective and nonelective endoscopy.
• Based on local prevalence rates, PPE, and test availability, in intermediate- and high-prevalence settings, preprocedure testing may be used to inform PPE decisions (N95 versus surgical mask). Additional benefits to testing are small and include deferring elective endoscopy in individuals testing positive and reducing anxiety among staff and patients.

As COVID-19 cases rise in the United States due to the Delta variant, there is renewed concern about infection and transmission of SARS-CoV-2 during endoscopy. In May 2021, AGA released updated recommendations on preprocedure testing post vaccination in the setting of ongoing population-wide vaccination programs for the prevention of COVID-19–related morbidity. In vaccinated individuals, breakthrough infections occurred very infrequently. Weighing the evidence demonstrating extremely low rates of rates of infection and transmission with vaccination and PPE, and considering the downsides of routine testing (burden, cost, false test results, increased disparities), AGA made a conditional recommendation against routine preprocedure testing for elective cases. The highly contagious Delta variant has now emerged as the predominant SARS-CoV2 virus in the U.S. and some data suggests that it may cause more severe illness than previous strains.  While more breakthrough infections may develop in fully vaccinated individuals, the greatest risk of infection, transmission and hospitalizations is among those who are unvaccinated.

• AGA suggests against reinstituting routine preprocedure testing prior to elective endoscopy. The downsides (delays in patient care, burden, inaccurate results) outweigh potential benefits. Infection and transmission of SARS-CoV-2 from asymptomatic individuals is rare especially among vaccinated health care workers using personal protective equipment (PPE), even with the emergence of the Delta variant.
• If PPE is available, AGA recommends using N95 for upper endoscopy and suggests using N95 or surgical masks for lower endoscopy (acknowledging that upper endoscopy is more aerosolizing than lower endoscopy) and continuation of elective and nonelective endoscopy.
• Based on local prevalence rates, PPE, and test availability, in intermediate- and high-prevalence settings, preprocedure testing may be used to inform PPE decisions (N95 versus surgical mask). Additional benefits to testing are small and include deferring elective endoscopy in individuals testing positive and reducing anxiety among staff and patients.

As COVID-19 cases rise in the United States due to the Delta variant, there is renewed concern about infection and transmission of SARS-CoV-2 during endoscopy. In May 2021, AGA released updated recommendations on preprocedure testing post vaccination in the setting of ongoing population-wide vaccination programs for the prevention of COVID-19–related morbidity. In vaccinated individuals, breakthrough infections occurred very infrequently. Weighing the evidence demonstrating extremely low rates of rates of infection and transmission with vaccination and PPE, and considering the downsides of routine testing (burden, cost, false test results, increased disparities), AGA made a conditional recommendation against routine preprocedure testing for elective cases. The highly contagious Delta variant has now emerged as the predominant SARS-CoV2 virus in the U.S. and some data suggests that it may cause more severe illness than previous strains.  While more breakthrough infections may develop in fully vaccinated individuals, the greatest risk of infection, transmission and hospitalizations is among those who are unvaccinated.

• AGA suggests against reinstituting routine preprocedure testing prior to elective endoscopy. The downsides (delays in patient care, burden, inaccurate results) outweigh potential benefits. Infection and transmission of SARS-CoV-2 from asymptomatic individuals is rare especially among vaccinated health care workers using personal protective equipment (PPE), even with the emergence of the Delta variant.
• If PPE is available, AGA recommends using N95 for upper endoscopy and suggests using N95 or surgical masks for lower endoscopy (acknowledging that upper endoscopy is more aerosolizing than lower endoscopy) and continuation of elective and nonelective endoscopy.
• Based on local prevalence rates, PPE, and test availability, in intermediate- and high-prevalence settings, preprocedure testing may be used to inform PPE decisions (N95 versus surgical mask). Additional benefits to testing are small and include deferring elective endoscopy in individuals testing positive and reducing anxiety among staff and patients.

AGA President John Inadomi, MD, and former AGA President David Lieberman, MD, along with American Cancer Society Cancer Action Network and Fight CRC, met with Assistant Secretary of Labor, Ali Khawar, and representatives from the U.S. Department of Health & Human Services and U.S. Department of Treasury to request they direct private health plans to cover colonoscopy after a positive noninvasive colorectal cancer (CRC) screening test.

The meeting was in response to an appeal sent to the three agencies, which provided guidance to health plans to ensure that workers have the benefits that have been agreed upon by their employers. As part of the Affordable Care Act, plans are mandated to cover colorectal cancer screening without cost sharing.

In May 2021, when the United States Preventive Services Task Force (USPFTF) lowered the recommended CRC screening age to 45, it also stated that “positive results on stool-based screening tests require follow-up with colonoscopy for the screening benefits to be achieved.”

To ensure that privately insured Americans receive proper CRC screening, AGA, ACS, and Fight CRC are pushing the government to provide written guidance to private plans clarifying that follow-up colonoscopies conducted after a positive noninvasive screening test are part of the colorectal cancer screening process and, therefore, patients should not face out-of-pocket costs when completing colorectal cancer screening.

Colorectal cancer remains the second leading killer in cancer in the United States despite the availability of preventive screening options. In 2018, just 68.8% of those eligible were screened for colorectal cancer. The challenge of getting people screened was exacerbated in 2020 when it is estimated that colorectal cancer screening declined by 86% during the first few months of the COVID-19 pandemic.

AGA President John Inadomi, MD, and former AGA President David Lieberman, MD, along with American Cancer Society Cancer Action Network and Fight CRC, met with Assistant Secretary of Labor, Ali Khawar, and representatives from the U.S. Department of Health & Human Services and U.S. Department of Treasury to request they direct private health plans to cover colonoscopy after a positive noninvasive colorectal cancer (CRC) screening test.

The meeting was in response to an appeal sent to the three agencies, which provided guidance to health plans to ensure that workers have the benefits that have been agreed upon by their employers. As part of the Affordable Care Act, plans are mandated to cover colorectal cancer screening without cost sharing.

In May 2021, when the United States Preventive Services Task Force (USPFTF) lowered the recommended CRC screening age to 45, it also stated that “positive results on stool-based screening tests require follow-up with colonoscopy for the screening benefits to be achieved.”

To ensure that privately insured Americans receive proper CRC screening, AGA, ACS, and Fight CRC are pushing the government to provide written guidance to private plans clarifying that follow-up colonoscopies conducted after a positive noninvasive screening test are part of the colorectal cancer screening process and, therefore, patients should not face out-of-pocket costs when completing colorectal cancer screening.

Colorectal cancer remains the second leading killer in cancer in the United States despite the availability of preventive screening options. In 2018, just 68.8% of those eligible were screened for colorectal cancer. The challenge of getting people screened was exacerbated in 2020 when it is estimated that colorectal cancer screening declined by 86% during the first few months of the COVID-19 pandemic.

AGA President John Inadomi, MD, and former AGA President David Lieberman, MD, along with American Cancer Society Cancer Action Network and Fight CRC, met with Assistant Secretary of Labor, Ali Khawar, and representatives from the U.S. Department of Health & Human Services and U.S. Department of Treasury to request they direct private health plans to cover colonoscopy after a positive noninvasive colorectal cancer (CRC) screening test.

The meeting was in response to an appeal sent to the three agencies, which provided guidance to health plans to ensure that workers have the benefits that have been agreed upon by their employers. As part of the Affordable Care Act, plans are mandated to cover colorectal cancer screening without cost sharing.

In May 2021, when the United States Preventive Services Task Force (USPFTF) lowered the recommended CRC screening age to 45, it also stated that “positive results on stool-based screening tests require follow-up with colonoscopy for the screening benefits to be achieved.”

To ensure that privately insured Americans receive proper CRC screening, AGA, ACS, and Fight CRC are pushing the government to provide written guidance to private plans clarifying that follow-up colonoscopies conducted after a positive noninvasive screening test are part of the colorectal cancer screening process and, therefore, patients should not face out-of-pocket costs when completing colorectal cancer screening.

Colorectal cancer remains the second leading killer in cancer in the United States despite the availability of preventive screening options. In 2018, just 68.8% of those eligible were screened for colorectal cancer. The challenge of getting people screened was exacerbated in 2020 when it is estimated that colorectal cancer screening declined by 86% during the first few months of the COVID-19 pandemic.

Interventional chest/diagnostic procedures

Endobronchial optical coherence tomography and interstitial lung diseases: Is the end near for surgical and transbronchial lung biopsies?

The early diagnosis of interstitial lung diseases (ILD) is paramount to initiating appropriate treatment and preventing irreversible pulmonary damage. Specific ILD subtypes may be diagnosed based on clinical evaluation, high resolution chest CT (HRCT) patterns, and serologic testing, but many patients require invasive procedures for histopathologic evaluation of lung tissue. Current modalities for obtaining tissue include transbronchial lung cryobiopsy (TBLC) and surgical lung biopsy (SLB), both of which carry a risk of potential complications (Troy LK, et al. Lancet Respir Med. 2020;8:171-81; Hutchinson JP, et al. Am J Respir Crit Care Med. 2016;193[10]:1161-7).

Recently, genomic classifiers applied to transbronchial biopsies have been proposed to facilitate the diagnosis of usual interstitial pneumonia (UIP), but the limited information provided still does not obviate the need for tissue diagnosis when needed (Raghu G, et al. Lancet Respir Med. 2019;7[6]:487-96). It is in this context that endobronchial optical coherence tomography (EB-OCT) was proposed as a real-time, in vivo, optical biopsy method for ILD.

EB-OCT uses near infrared light to generate large volumes of in-vivo three-dimensional tissue imaging with microscopic resolution (Goorsenberg A, et al. Respiration. 2020;99:190-205; Nandy S, et al. Am J Respir Crit Care Med. 2021;article in press). The OCT catheter is advanced through the bronchoscope working channel and can be used during outpatient procedures under conscious sedation. Available data suggests that minimal training is necessary, both for proceduralists and interpreting pathologists, but this will need to be confirmed in larger studies and various practice settings. Early studies suggest that OCT can identify microscopic honeycombing and other abnormalities even before they are evident on HRCT scans (Goorsenberg A, et al. Respiration. 2020;99:190-205). Newer research comparing ILD diagnosis from EB-OCT cross-sectional images with that obtained from SLB specimens revealed EB-OCT can distinguish UIP from non-UIP ILD with high sensitivity and specificity (Nandy S, et al. Am J Respir Crit Care Med. 2021;article in press). Could this mean the end of SLB and TBLC for the diagnosis of ILD? While the ability to diagnose ILD subtypes with high reliability and low risk of complications is certainly promising, studies remain admittedly small and the technique itself is only available to highly select individuals and specialized ILD centers. Let’s not pack up the cryoprobe just yet.

Audra J. Schwalk, MD, MBA: Steering Committee Member

Fabien Maldonado, MD, FCCP: Steering Committee Member
 

Pediatric chest medicine

Challenges in the pediatric pulmonary workforce

The future of the pediatric workforce has been the source of extensive discussion within the pediatric community and resulted in a considerable body of medical literature (Vinci RJ. Pediatrics. 2021;147[6]:e2020013292). In pediatric pulmonology, there is growing concern that current trends will lead to a workforce shortage resulting in patients having difficulty accessing subspecialty care (Harris C, et al. Pediatric Pulmonol. 2019;54[4]:444-50). The etiology of this shortage is multifactorial. Duration of fellowship training and subsequent financial implications are reported potential barriers to pursuing a fellowship (Nelson BA, et al. Pediatric Pulmonol. 2020;1-7). Discrepancies between pediatric and adult compensation may be another barrier. Insightful recruitment strategies based on the results of a recent study included maximizing resident interaction with pulmonary faculty, early identification and support of interested trainees, and consideration of flexible training models (Nelson BA, et al. ATS Sch. 2020;1:372-83). Lifestyle has also been a factor that contributes to a trainee’s decision to go into pediatric pulmonology (Freed GL, et al. Pediatrics. 2009;123(suppl 1):S31‐S37).

Pulmonary vascular disease

Cascade testing in PAH: Is there a role?

Pediatric guidelines for pulmonary arterial hypertension (PAH) recommends genetic screening as a part of the evaluation for the newly diagnosed, with expansion to first-degree relatives as indicated. Currently, this is not mandated, and implementation is variable. In adults, genetic screening is not routinely offered, and family screening is rare. This reflects a lack of definitive guidelines (Abman SH, et al. Circulation. 2015:24;132[21]:2037-99). However, it is intuitive that if carriers are not identified by screening, they will come to attention after pulmonary vascular disease burden causes symptoms and affects outcomes.

Pulmonary physiology, function, and rehabilitation network

Physiological benefits of awake proning: Its role and relevance in the COVID-19 pandemic

The advent of the COVID-19 pandemic has put a significant strain on the health care systems and critical care services across several countries, including the United States. Amidst this, several concerted efforts to reduce the need for mechanical ventilation has resulted in the emergence of awake proning as a strategy to improve oxygenation, which has been instituted in critical care units, in-patient settings, as well as in EDs. Although the evidence on this strategy has been vastly limited to case series and observational studies, several societies have incorporated awake proning as an initial management strategy in hypoxemic respiratory failure within their clinical guidelines (Chalmers JD, et al. Eur Respir J. 2021;57:2100048; Koeckerling D, et al. Thorax. 2020;75:833-4) and consensus statements (Nasa P, et al. Crit Care. 2021;25:106).

Physiological benefits of awake proning include improvement in ventilation-perfusion matching secondary to relative increase in ventilation in dorsal nondependent areas in the setting of higher density of perfusion within these units, thus reducing shunt and, hence, improving oxygenation. Other physiological mechanisms include homogenization of transpulmonary pressures, reduction of ventilator-induced lung injury (VILI) or patient self-inflicted lung injury (P-SILI), and possibly lung injury from pendelluft (Telias I, et al. JAMA. 2020;323[22]:2265-67).

A recent meta-trial involving randomized controlled trials done across six countries compared prone positioning with standard care in patients with hypoxemic respiratory failure (defined as SpO₂/ FiO₂ < 315 and on high flow oxygen therapy) showed a reduced incidence of treatment failure and need for intubation without any signal of harm; although no mortality benefit was reported (Ehrmann S, et al. Lancet Respir Med. 2021 Aug 20;S2213-2600(21)00356-8). The number needed to treat to prevent one intubation was 14. While promising and reinforcing the safety of this relatively easy maneuver, several questions remain—which patients would benefit the most? Can it be applied within general wards safely? Does institution of awake proning delay intubation rates with consequent worse outcomes? Several ongoing (NCT 04402879) and completed studies (NCT 04383613 and NCT 04350723) may shed light on these important questions (Weatherald J, et al. Lancet Respir Med. 2021 Aug 20;S2213-2600[21]00368-4).

Sujith Cherian, MD, FCCP: Steering Committee Member

Interventional chest/diagnostic procedures

Endobronchial optical coherence tomography and interstitial lung diseases: Is the end near for surgical and transbronchial lung biopsies?

The early diagnosis of interstitial lung diseases (ILD) is paramount to initiating appropriate treatment and preventing irreversible pulmonary damage. Specific ILD subtypes may be diagnosed based on clinical evaluation, high resolution chest CT (HRCT) patterns, and serologic testing, but many patients require invasive procedures for histopathologic evaluation of lung tissue. Current modalities for obtaining tissue include transbronchial lung cryobiopsy (TBLC) and surgical lung biopsy (SLB), both of which carry a risk of potential complications (Troy LK, et al. Lancet Respir Med. 2020;8:171-81; Hutchinson JP, et al. Am J Respir Crit Care Med. 2016;193[10]:1161-7).

Recently, genomic classifiers applied to transbronchial biopsies have been proposed to facilitate the diagnosis of usual interstitial pneumonia (UIP), but the limited information provided still does not obviate the need for tissue diagnosis when needed (Raghu G, et al. Lancet Respir Med. 2019;7[6]:487-96). It is in this context that endobronchial optical coherence tomography (EB-OCT) was proposed as a real-time, in vivo, optical biopsy method for ILD.

EB-OCT uses near infrared light to generate large volumes of in-vivo three-dimensional tissue imaging with microscopic resolution (Goorsenberg A, et al. Respiration. 2020;99:190-205; Nandy S, et al. Am J Respir Crit Care Med. 2021;article in press). The OCT catheter is advanced through the bronchoscope working channel and can be used during outpatient procedures under conscious sedation. Available data suggests that minimal training is necessary, both for proceduralists and interpreting pathologists, but this will need to be confirmed in larger studies and various practice settings. Early studies suggest that OCT can identify microscopic honeycombing and other abnormalities even before they are evident on HRCT scans (Goorsenberg A, et al. Respiration. 2020;99:190-205). Newer research comparing ILD diagnosis from EB-OCT cross-sectional images with that obtained from SLB specimens revealed EB-OCT can distinguish UIP from non-UIP ILD with high sensitivity and specificity (Nandy S, et al. Am J Respir Crit Care Med. 2021;article in press). Could this mean the end of SLB and TBLC for the diagnosis of ILD? While the ability to diagnose ILD subtypes with high reliability and low risk of complications is certainly promising, studies remain admittedly small and the technique itself is only available to highly select individuals and specialized ILD centers. Let’s not pack up the cryoprobe just yet.

Audra J. Schwalk, MD, MBA: Steering Committee Member

Fabien Maldonado, MD, FCCP: Steering Committee Member
 

Pediatric chest medicine

Challenges in the pediatric pulmonary workforce

The future of the pediatric workforce has been the source of extensive discussion within the pediatric community and resulted in a considerable body of medical literature (Vinci RJ. Pediatrics. 2021;147[6]:e2020013292). In pediatric pulmonology, there is growing concern that current trends will lead to a workforce shortage resulting in patients having difficulty accessing subspecialty care (Harris C, et al. Pediatric Pulmonol. 2019;54[4]:444-50). The etiology of this shortage is multifactorial. Duration of fellowship training and subsequent financial implications are reported potential barriers to pursuing a fellowship (Nelson BA, et al. Pediatric Pulmonol. 2020;1-7). Discrepancies between pediatric and adult compensation may be another barrier. Insightful recruitment strategies based on the results of a recent study included maximizing resident interaction with pulmonary faculty, early identification and support of interested trainees, and consideration of flexible training models (Nelson BA, et al. ATS Sch. 2020;1:372-83). Lifestyle has also been a factor that contributes to a trainee’s decision to go into pediatric pulmonology (Freed GL, et al. Pediatrics. 2009;123(suppl 1):S31‐S37).

Pulmonary vascular disease

Cascade testing in PAH: Is there a role?

Pediatric guidelines for pulmonary arterial hypertension (PAH) recommends genetic screening as a part of the evaluation for the newly diagnosed, with expansion to first-degree relatives as indicated. Currently, this is not mandated, and implementation is variable. In adults, genetic screening is not routinely offered, and family screening is rare. This reflects a lack of definitive guidelines (Abman SH, et al. Circulation. 2015:24;132[21]:2037-99). However, it is intuitive that if carriers are not identified by screening, they will come to attention after pulmonary vascular disease burden causes symptoms and affects outcomes.

Pulmonary physiology, function, and rehabilitation network

Physiological benefits of awake proning: Its role and relevance in the COVID-19 pandemic

The advent of the COVID-19 pandemic has put a significant strain on the health care systems and critical care services across several countries, including the United States. Amidst this, several concerted efforts to reduce the need for mechanical ventilation has resulted in the emergence of awake proning as a strategy to improve oxygenation, which has been instituted in critical care units, in-patient settings, as well as in EDs. Although the evidence on this strategy has been vastly limited to case series and observational studies, several societies have incorporated awake proning as an initial management strategy in hypoxemic respiratory failure within their clinical guidelines (Chalmers JD, et al. Eur Respir J. 2021;57:2100048; Koeckerling D, et al. Thorax. 2020;75:833-4) and consensus statements (Nasa P, et al. Crit Care. 2021;25:106).

Physiological benefits of awake proning include improvement in ventilation-perfusion matching secondary to relative increase in ventilation in dorsal nondependent areas in the setting of higher density of perfusion within these units, thus reducing shunt and, hence, improving oxygenation. Other physiological mechanisms include homogenization of transpulmonary pressures, reduction of ventilator-induced lung injury (VILI) or patient self-inflicted lung injury (P-SILI), and possibly lung injury from pendelluft (Telias I, et al. JAMA. 2020;323[22]:2265-67).

A recent meta-trial involving randomized controlled trials done across six countries compared prone positioning with standard care in patients with hypoxemic respiratory failure (defined as SpO₂/ FiO₂ < 315 and on high flow oxygen therapy) showed a reduced incidence of treatment failure and need for intubation without any signal of harm; although no mortality benefit was reported (Ehrmann S, et al. Lancet Respir Med. 2021 Aug 20;S2213-2600(21)00356-8). The number needed to treat to prevent one intubation was 14. While promising and reinforcing the safety of this relatively easy maneuver, several questions remain—which patients would benefit the most? Can it be applied within general wards safely? Does institution of awake proning delay intubation rates with consequent worse outcomes? Several ongoing (NCT 04402879) and completed studies (NCT 04383613 and NCT 04350723) may shed light on these important questions (Weatherald J, et al. Lancet Respir Med. 2021 Aug 20;S2213-2600[21]00368-4).

Sujith Cherian, MD, FCCP: Steering Committee Member

Interventional chest/diagnostic procedures

Endobronchial optical coherence tomography and interstitial lung diseases: Is the end near for surgical and transbronchial lung biopsies?

The early diagnosis of interstitial lung diseases (ILD) is paramount to initiating appropriate treatment and preventing irreversible pulmonary damage. Specific ILD subtypes may be diagnosed based on clinical evaluation, high resolution chest CT (HRCT) patterns, and serologic testing, but many patients require invasive procedures for histopathologic evaluation of lung tissue. Current modalities for obtaining tissue include transbronchial lung cryobiopsy (TBLC) and surgical lung biopsy (SLB), both of which carry a risk of potential complications (Troy LK, et al. Lancet Respir Med. 2020;8:171-81; Hutchinson JP, et al. Am J Respir Crit Care Med. 2016;193[10]:1161-7).

Recently, genomic classifiers applied to transbronchial biopsies have been proposed to facilitate the diagnosis of usual interstitial pneumonia (UIP), but the limited information provided still does not obviate the need for tissue diagnosis when needed (Raghu G, et al. Lancet Respir Med. 2019;7[6]:487-96). It is in this context that endobronchial optical coherence tomography (EB-OCT) was proposed as a real-time, in vivo, optical biopsy method for ILD.

EB-OCT uses near infrared light to generate large volumes of in-vivo three-dimensional tissue imaging with microscopic resolution (Goorsenberg A, et al. Respiration. 2020;99:190-205; Nandy S, et al. Am J Respir Crit Care Med. 2021;article in press). The OCT catheter is advanced through the bronchoscope working channel and can be used during outpatient procedures under conscious sedation. Available data suggests that minimal training is necessary, both for proceduralists and interpreting pathologists, but this will need to be confirmed in larger studies and various practice settings. Early studies suggest that OCT can identify microscopic honeycombing and other abnormalities even before they are evident on HRCT scans (Goorsenberg A, et al. Respiration. 2020;99:190-205). Newer research comparing ILD diagnosis from EB-OCT cross-sectional images with that obtained from SLB specimens revealed EB-OCT can distinguish UIP from non-UIP ILD with high sensitivity and specificity (Nandy S, et al. Am J Respir Crit Care Med. 2021;article in press). Could this mean the end of SLB and TBLC for the diagnosis of ILD? While the ability to diagnose ILD subtypes with high reliability and low risk of complications is certainly promising, studies remain admittedly small and the technique itself is only available to highly select individuals and specialized ILD centers. Let’s not pack up the cryoprobe just yet.

Audra J. Schwalk, MD, MBA: Steering Committee Member

Fabien Maldonado, MD, FCCP: Steering Committee Member
 

Pediatric chest medicine

Challenges in the pediatric pulmonary workforce

The future of the pediatric workforce has been the source of extensive discussion within the pediatric community and resulted in a considerable body of medical literature (Vinci RJ. Pediatrics. 2021;147[6]:e2020013292). In pediatric pulmonology, there is growing concern that current trends will lead to a workforce shortage resulting in patients having difficulty accessing subspecialty care (Harris C, et al. Pediatric Pulmonol. 2019;54[4]:444-50). The etiology of this shortage is multifactorial. Duration of fellowship training and subsequent financial implications are reported potential barriers to pursuing a fellowship (Nelson BA, et al. Pediatric Pulmonol. 2020;1-7). Discrepancies between pediatric and adult compensation may be another barrier. Insightful recruitment strategies based on the results of a recent study included maximizing resident interaction with pulmonary faculty, early identification and support of interested trainees, and consideration of flexible training models (Nelson BA, et al. ATS Sch. 2020;1:372-83). Lifestyle has also been a factor that contributes to a trainee’s decision to go into pediatric pulmonology (Freed GL, et al. Pediatrics. 2009;123(suppl 1):S31‐S37).

Pulmonary vascular disease

Cascade testing in PAH: Is there a role?

Pediatric guidelines for pulmonary arterial hypertension (PAH) recommends genetic screening as a part of the evaluation for the newly diagnosed, with expansion to first-degree relatives as indicated. Currently, this is not mandated, and implementation is variable. In adults, genetic screening is not routinely offered, and family screening is rare. This reflects a lack of definitive guidelines (Abman SH, et al. Circulation. 2015:24;132[21]:2037-99). However, it is intuitive that if carriers are not identified by screening, they will come to attention after pulmonary vascular disease burden causes symptoms and affects outcomes.

Pulmonary physiology, function, and rehabilitation network

Physiological benefits of awake proning: Its role and relevance in the COVID-19 pandemic

The advent of the COVID-19 pandemic has put a significant strain on the health care systems and critical care services across several countries, including the United States. Amidst this, several concerted efforts to reduce the need for mechanical ventilation has resulted in the emergence of awake proning as a strategy to improve oxygenation, which has been instituted in critical care units, in-patient settings, as well as in EDs. Although the evidence on this strategy has been vastly limited to case series and observational studies, several societies have incorporated awake proning as an initial management strategy in hypoxemic respiratory failure within their clinical guidelines (Chalmers JD, et al. Eur Respir J. 2021;57:2100048; Koeckerling D, et al. Thorax. 2020;75:833-4) and consensus statements (Nasa P, et al. Crit Care. 2021;25:106).

Physiological benefits of awake proning include improvement in ventilation-perfusion matching secondary to relative increase in ventilation in dorsal nondependent areas in the setting of higher density of perfusion within these units, thus reducing shunt and, hence, improving oxygenation. Other physiological mechanisms include homogenization of transpulmonary pressures, reduction of ventilator-induced lung injury (VILI) or patient self-inflicted lung injury (P-SILI), and possibly lung injury from pendelluft (Telias I, et al. JAMA. 2020;323[22]:2265-67).

A recent meta-trial involving randomized controlled trials done across six countries compared prone positioning with standard care in patients with hypoxemic respiratory failure (defined as SpO₂/ FiO₂ < 315 and on high flow oxygen therapy) showed a reduced incidence of treatment failure and need for intubation without any signal of harm; although no mortality benefit was reported (Ehrmann S, et al. Lancet Respir Med. 2021 Aug 20;S2213-2600(21)00356-8). The number needed to treat to prevent one intubation was 14. While promising and reinforcing the safety of this relatively easy maneuver, several questions remain—which patients would benefit the most? Can it be applied within general wards safely? Does institution of awake proning delay intubation rates with consequent worse outcomes? Several ongoing (NCT 04402879) and completed studies (NCT 04383613 and NCT 04350723) may shed light on these important questions (Weatherald J, et al. Lancet Respir Med. 2021 Aug 20;S2213-2600[21]00368-4).

Sujith Cherian, MD, FCCP: Steering Committee Member

I am honored to have the privilege of serving as the 84th President of the American College of Chest Physicians. When I attended my first CHEST meeting, I sat in the opening plenary session with thousands of other members, never imagining that I would have the opportunity to lead the organization just two decades later. And while I don’t recall many sessions from that meeting, I vividly remember the way it made an emotional impact. I never felt like one of a drove of nameless learners; both faculty and staff made it a collegial experience, much like attending pulmonary grand rounds at my own institution. Speakers would stay after their presentations to answer questions from even the most junior members. Leadership made themselves available over coffee or in the hallways between sessions. And that experience was the first of a great many memorable interactions I have had with CHEST.

Courtesy of American College of Chest Physicians

CHEST has meant a great deal to me personally; it served as my first professional home away from home. I had the opportunity to grow in a number of different areas through my service to CHEST, in ways that I would not have been able to do easily at my own institution. I’ve worked with incredible staff and volunteers in my service on a number of our committees, including the Council of NetWorks, the Training and Transitions Committee, the Education Committee, and the Program Committee, to name a few. While I’ve had a chance to learn what role each of these component parts of the College serves during my tenure on those committees, it wasn’t until far more recently that I better understood the role of the President. Before I get into what I’d like to achieve during my year as President, I’d like to briefly review what that role entails.

Contrary to popular belief, the President does not set the organizational goals for CHEST; those are set by the Board of Regents. While I will have the privilege of running the Board meetings, it is the seventeen incredibly talented folks who serve as voting members of the Board that set the College’s direction. Once the organizational goals are set, it is our committees that take charge of designing and implementing plans to work toward those goals. Concomitantly, Dr. Robert Musacchio (CHEST chief executive officer and executive vice president) meets with his own executive leadership team to design a structure that lets the CHEST staff work, both on their own and in tandem with our members, to achieve these goals. One of the President’s main roles, as I see it, is to serve as a liaison. When the Board makes decisions that affect the membership, it will be my job to communicate changes and why they are being made. When our members have challenges that the College might be able to help solve, it is my role to work with the Board and the CEO to see what we can do about them. And when there is need to interface with other organizations, the President (or their designee) can speak on behalf of the College in those interactions.

In the context of those duties, what are the things that I would like to accomplish during my tenure as CHEST president? First, I want to spend more time with our committees and you, our members. CHEST is a member-focused organization; I believe that this is the main thing that sets our professional society apart from its sister societies. I have always found CHEST to be very collegial and welcoming. But I am aware that some of our members haven’t always found it accessible. And I get that; our structure is complex. That’s the reason I provided a description of my role, and the reason that I intend to spend time making CHEST more accessible to all of you. We’ve already developed dedicated social media channels for a number of our NetWorks in order to make you all more aware of their activities. In the coming year, I’ll provide regular updates to membership about ongoing CHEST activities. I’ll work to provide more member awareness of what role each of our committees plays in forwarding the College’s goals. And I’ll provide you with more information about the type of qualifications that each committee seeks in its nominees, in an effort to encourage you to run for a leadership position that best suits your interests and skill set.

While improving our members’ understanding of the inner workings at CHEST will help each of you better see how the College can meet your needs, my hope is that this increase in organizational accessibility will motivate each of you to engage more actively with us. This is my second goal as President. For some of you, that engagement may take the form of joining our Twitter chats; for others, it could mean attending one of our live learning courses in Chicago for the first time. But I hope that some of you will consider submitting session proposals to our annual meeting for the first time, or running for an available leadership position within the College when nominations open in the Spring.

As our organization grows (now almost twenty thousand members strong!), I want to provide a second home for all our members, spanning the range from medical students to full professors, from lifelong academic physicians to those just starting out in community practices, from busy clinicians to physician scientists, and including all members of the healthcare team. Although the makeup of our volunteer leadership is becoming more representative of the full breadth of our membership, we are not fully there yet. Until we get to that intended target, I would like to ask each of you to reach out to me with any thoughts about how CHEST can better meet your professional needs. Creating greater access to leadership to let each of your opinions be heard is my third goal as President of CHEST. I’ll provide more details about how I’m hoping to achieve this in the coming months.

The world has been a crazy place over the last eighteen months, filled with challenges that we could never have foreseen even a year prior. Our members have been on the front lines of the pandemic; in addition to the professional stresses related to caring for innumerable critically ill patients, many of us have suffered personal losses. Although none of us knows what 2022 holds, I look forward to a brighter future, knowing that regardless of what the coming year brings, we will face it together.

I am honored to have the privilege of serving as the 84th President of the American College of Chest Physicians. When I attended my first CHEST meeting, I sat in the opening plenary session with thousands of other members, never imagining that I would have the opportunity to lead the organization just two decades later. And while I don’t recall many sessions from that meeting, I vividly remember the way it made an emotional impact. I never felt like one of a drove of nameless learners; both faculty and staff made it a collegial experience, much like attending pulmonary grand rounds at my own institution. Speakers would stay after their presentations to answer questions from even the most junior members. Leadership made themselves available over coffee or in the hallways between sessions. And that experience was the first of a great many memorable interactions I have had with CHEST.

Courtesy of American College of Chest Physicians

CHEST has meant a great deal to me personally; it served as my first professional home away from home. I had the opportunity to grow in a number of different areas through my service to CHEST, in ways that I would not have been able to do easily at my own institution. I’ve worked with incredible staff and volunteers in my service on a number of our committees, including the Council of NetWorks, the Training and Transitions Committee, the Education Committee, and the Program Committee, to name a few. While I’ve had a chance to learn what role each of these component parts of the College serves during my tenure on those committees, it wasn’t until far more recently that I better understood the role of the President. Before I get into what I’d like to achieve during my year as President, I’d like to briefly review what that role entails.

Contrary to popular belief, the President does not set the organizational goals for CHEST; those are set by the Board of Regents. While I will have the privilege of running the Board meetings, it is the seventeen incredibly talented folks who serve as voting members of the Board that set the College’s direction. Once the organizational goals are set, it is our committees that take charge of designing and implementing plans to work toward those goals. Concomitantly, Dr. Robert Musacchio (CHEST chief executive officer and executive vice president) meets with his own executive leadership team to design a structure that lets the CHEST staff work, both on their own and in tandem with our members, to achieve these goals. One of the President’s main roles, as I see it, is to serve as a liaison. When the Board makes decisions that affect the membership, it will be my job to communicate changes and why they are being made. When our members have challenges that the College might be able to help solve, it is my role to work with the Board and the CEO to see what we can do about them. And when there is need to interface with other organizations, the President (or their designee) can speak on behalf of the College in those interactions.

In the context of those duties, what are the things that I would like to accomplish during my tenure as CHEST president? First, I want to spend more time with our committees and you, our members. CHEST is a member-focused organization; I believe that this is the main thing that sets our professional society apart from its sister societies. I have always found CHEST to be very collegial and welcoming. But I am aware that some of our members haven’t always found it accessible. And I get that; our structure is complex. That’s the reason I provided a description of my role, and the reason that I intend to spend time making CHEST more accessible to all of you. We’ve already developed dedicated social media channels for a number of our NetWorks in order to make you all more aware of their activities. In the coming year, I’ll provide regular updates to membership about ongoing CHEST activities. I’ll work to provide more member awareness of what role each of our committees plays in forwarding the College’s goals. And I’ll provide you with more information about the type of qualifications that each committee seeks in its nominees, in an effort to encourage you to run for a leadership position that best suits your interests and skill set.

While improving our members’ understanding of the inner workings at CHEST will help each of you better see how the College can meet your needs, my hope is that this increase in organizational accessibility will motivate each of you to engage more actively with us. This is my second goal as President. For some of you, that engagement may take the form of joining our Twitter chats; for others, it could mean attending one of our live learning courses in Chicago for the first time. But I hope that some of you will consider submitting session proposals to our annual meeting for the first time, or running for an available leadership position within the College when nominations open in the Spring.

As our organization grows (now almost twenty thousand members strong!), I want to provide a second home for all our members, spanning the range from medical students to full professors, from lifelong academic physicians to those just starting out in community practices, from busy clinicians to physician scientists, and including all members of the healthcare team. Although the makeup of our volunteer leadership is becoming more representative of the full breadth of our membership, we are not fully there yet. Until we get to that intended target, I would like to ask each of you to reach out to me with any thoughts about how CHEST can better meet your professional needs. Creating greater access to leadership to let each of your opinions be heard is my third goal as President of CHEST. I’ll provide more details about how I’m hoping to achieve this in the coming months.

The world has been a crazy place over the last eighteen months, filled with challenges that we could never have foreseen even a year prior. Our members have been on the front lines of the pandemic; in addition to the professional stresses related to caring for innumerable critically ill patients, many of us have suffered personal losses. Although none of us knows what 2022 holds, I look forward to a brighter future, knowing that regardless of what the coming year brings, we will face it together.

I am honored to have the privilege of serving as the 84th President of the American College of Chest Physicians. When I attended my first CHEST meeting, I sat in the opening plenary session with thousands of other members, never imagining that I would have the opportunity to lead the organization just two decades later. And while I don’t recall many sessions from that meeting, I vividly remember the way it made an emotional impact. I never felt like one of a drove of nameless learners; both faculty and staff made it a collegial experience, much like attending pulmonary grand rounds at my own institution. Speakers would stay after their presentations to answer questions from even the most junior members. Leadership made themselves available over coffee or in the hallways between sessions. And that experience was the first of a great many memorable interactions I have had with CHEST.

Courtesy of American College of Chest Physicians

CHEST has meant a great deal to me personally; it served as my first professional home away from home. I had the opportunity to grow in a number of different areas through my service to CHEST, in ways that I would not have been able to do easily at my own institution. I’ve worked with incredible staff and volunteers in my service on a number of our committees, including the Council of NetWorks, the Training and Transitions Committee, the Education Committee, and the Program Committee, to name a few. While I’ve had a chance to learn what role each of these component parts of the College serves during my tenure on those committees, it wasn’t until far more recently that I better understood the role of the President. Before I get into what I’d like to achieve during my year as President, I’d like to briefly review what that role entails.

Contrary to popular belief, the President does not set the organizational goals for CHEST; those are set by the Board of Regents. While I will have the privilege of running the Board meetings, it is the seventeen incredibly talented folks who serve as voting members of the Board that set the College’s direction. Once the organizational goals are set, it is our committees that take charge of designing and implementing plans to work toward those goals. Concomitantly, Dr. Robert Musacchio (CHEST chief executive officer and executive vice president) meets with his own executive leadership team to design a structure that lets the CHEST staff work, both on their own and in tandem with our members, to achieve these goals. One of the President’s main roles, as I see it, is to serve as a liaison. When the Board makes decisions that affect the membership, it will be my job to communicate changes and why they are being made. When our members have challenges that the College might be able to help solve, it is my role to work with the Board and the CEO to see what we can do about them. And when there is need to interface with other organizations, the President (or their designee) can speak on behalf of the College in those interactions.

In the context of those duties, what are the things that I would like to accomplish during my tenure as CHEST president? First, I want to spend more time with our committees and you, our members. CHEST is a member-focused organization; I believe that this is the main thing that sets our professional society apart from its sister societies. I have always found CHEST to be very collegial and welcoming. But I am aware that some of our members haven’t always found it accessible. And I get that; our structure is complex. That’s the reason I provided a description of my role, and the reason that I intend to spend time making CHEST more accessible to all of you. We’ve already developed dedicated social media channels for a number of our NetWorks in order to make you all more aware of their activities. In the coming year, I’ll provide regular updates to membership about ongoing CHEST activities. I’ll work to provide more member awareness of what role each of our committees plays in forwarding the College’s goals. And I’ll provide you with more information about the type of qualifications that each committee seeks in its nominees, in an effort to encourage you to run for a leadership position that best suits your interests and skill set.

While improving our members’ understanding of the inner workings at CHEST will help each of you better see how the College can meet your needs, my hope is that this increase in organizational accessibility will motivate each of you to engage more actively with us. This is my second goal as President. For some of you, that engagement may take the form of joining our Twitter chats; for others, it could mean attending one of our live learning courses in Chicago for the first time. But I hope that some of you will consider submitting session proposals to our annual meeting for the first time, or running for an available leadership position within the College when nominations open in the Spring.

As our organization grows (now almost twenty thousand members strong!), I want to provide a second home for all our members, spanning the range from medical students to full professors, from lifelong academic physicians to those just starting out in community practices, from busy clinicians to physician scientists, and including all members of the healthcare team. Although the makeup of our volunteer leadership is becoming more representative of the full breadth of our membership, we are not fully there yet. Until we get to that intended target, I would like to ask each of you to reach out to me with any thoughts about how CHEST can better meet your professional needs. Creating greater access to leadership to let each of your opinions be heard is my third goal as President of CHEST. I’ll provide more details about how I’m hoping to achieve this in the coming months.

The world has been a crazy place over the last eighteen months, filled with challenges that we could never have foreseen even a year prior. Our members have been on the front lines of the pandemic; in addition to the professional stresses related to caring for innumerable critically ill patients, many of us have suffered personal losses. Although none of us knows what 2022 holds, I look forward to a brighter future, knowing that regardless of what the coming year brings, we will face it together.