An editorial article by Artemio Garcia (Regent for South American Endoscopy Association), and Silvia Quadrelli (Argentina)

Argentina has an estimated population of 43 million. The Association for Respiratory Medicine has a membership of 2500 and the Argentinean Association for Bronchology (AABE), about 300. Bronchoscopy training is included in the curriculum during residency and in University postgraduate Pulmonary Medicine programs. Additionally, the AABE runs an annual Postgraduate Certification Course for specialists in Pulmonary, Intensive Care or Thoracic Surgery, specifically devoted to training in flexible bronchoscopy. It includes didactic lectures and Problem-based learning (PBL) activities, but mainly practical training adhering to Bronchoscopy Education Program techniques and contents with an initial phase of training on inanimate models and no less than 100 supervised bronchoscopies in patients. Checklists and validated assessment tools are used to monitor progress along the trainee’s learning curve. There is an additional educational program for training in rigid bronchoscopy for a select number of individuals. While completion of the Postgraduate Course is not a formal requirement to practice bronchoscopy, certification is strongly encouraged by all the major institutions.

Bronchoscopy is performed in every private and public hospital in the major cities and is available all over the Argentinean geography in mid-level complexity institutions. More than 80% of bronchoscopists are pulmonologists. In smaller cities, thoracic surgeons are often in charge of performing bronchoscopy. Interventional bronchoscopy is available in all the major cities, but remote areas of the country usually require transfer to larger institutions. Therapeutic bronchoscopy with dilation, stent placement and electrocautery is available in most of the large cities. A few major institutions are able to provide cryobiopsy, laser resection, bronchial thermoplasty, NBI or placement of bronchial valves.

Main indications for bronchoscopy in Argentina are the investigation of hemoptysis, suspicion of lung cancer and bacteriological analysis. In some geographical areas and selected hospitals, tuberculosis is still a major diagnostic indication. Sedation is routinely performed in private institutions, always with the cooperation of certified anesthesiologists. In public institutions, more than 50% of standard diagnostic procedures are performed under local anesthesia.

The strong support of the WABIP has allowed the Argentinean Association to provide training in bronchoscopy to several countries in South America, and Argentina is a frequent destination for longer training of many South American pulmonologists.