Summer schools of adult and paediatric respiratory medicine: course report

Overview from the faculty, Stylianos Loukides and Gabor Kovacs

The European Respiratory Society (ERS) has a long tradition of organising major congresses and courses in various areas of respiratory medicine in order to share knowledge and promote clinical education. The courses are led by respiratory specialists committed to the ERS and having great experience in the field. One of the most important courses is the ERS Summer School of Adult Respiratory Medicine. This particular course aims to provide a detailed overview of up-to-date, established clinical knowledge, mainly for early career respiratory physicians. It discusses the most important questions of respiratory medicine, including obstructive airway diseases, respiratory infections, tuberculosis, cystic fibrosis, bronchiectasis, lung cancer, mesothelioma, pleural diseases, sleep disorders, vascular diseases, interstitial lung diseases, sarcoidosis, lung function tests and imaging. The course represents an ideal tool for the preparation for the HERMES diploma.

The course held in June 2019 was the eighth of its kind; the first summer school took place in Barcelona, Spain, back in 2012. Ever since, the summer school has taken place five more times in Barcelona and twice in Lisbon, Portugal (2016 and 2018). There have been 438 Summer School participants altogether, coming from 58 countries.

The 4-day course is set up for respiratory physicians who have already finished their training or are in their final year. The content of the sessions and the educational material are mainly based on guidelines and position papers reflecting evidence-based medicine. The experts also challenge the participants with a multiple-choice questionnaire (MCQ) after each presentation in order to test their knowledge.

We organisers hope that participants of the summer school had the opportunity to meet experts and colleagues from other countries widening their knowledge in respiratory medicine. We also hope that by the end of the course, they became more familiar with current clinical guidelines and took home practical knowledge that they use in their daily work.

After the summer school this year, several colleagues participated at the HERMES self-assessment course. This gave the opportunity to sit the shortened version of the HERMES exam, including 30 MCQ questions. At the end of the examination, all questions were discussed. Weorganisers believe that this was a good experience for colleagues planning to apply for the HERMES exam at the ERS Congress. They could test their knowledge and received feedback from the faculty. As the current session revealed, some candidates were very well prepared already and would have a good chance to pass the real exam.

We hope that, as at each of the previous summer schools, this year, we could provide participants with up-to-date, evidence-based clinical knowledge, we were able to share a professional and practical way of medical thinking, and we could represent the values of the ERS. We believe that colleagues from all countries who participated in these high-level educational courses and successfully prepared for the HERMES exam fulfil the highest European educational standards, and may form a core of respiratory physicians taking increasing responsibility in our society in the future.

Kada Bentata, Algeria, a participant

When arriving at the course, I was quite worried about the atmosphere because it was my first participation in such a course. However, after the first contact with the ERS team – who were very professional and friendly – I was very confident and relaxed, and my appetite for knowledge was whetted. The course had an intimate atmosphere, with great knowledge and skills provided by international experts in the field. I was like a person lost in the desert who finally finds an oasis. There was excellent organisation with a constructive atmosphere.

All topics were interesting and very well presented by the faculty. Of course, some topics appeared even more attractive than others. For example, asthma, COPD and obstructive sleep apnoea were especially interesting due to the frequency of these diseases and the new emerging treatments. Pleural diseases, very well exposed by Prof. Rahman, were interesting due to the availability of new diagnostic and treatment tools to facilitate the management of the disease. Lung cancer was presented very well by Prof. Huber, who has great experience in the field. Lung imaging was a very interesting topic too and its implications in the management of most lung diseases were clearly highlighted.

I learned so much from this course. The main concepts that were very useful for me regarding my daily practice concern the pleural diseases, lung cancer, sleep apnoea and interstitial lung diseases (ILD).

• In pleural diseases, I learned some new tools to improve my diagnostic strategy for pleural effusion, especially malignant and infectious ones.

• In sleep apnoea, the talk and the workshop were very useful, and helped me to manage some cases of this disease.

• The talk about ILD, and the imaging conference and workshop, were very helpful to narrow the diagnosis of ILDs, which are very complicated in our medical practice, so we can improve their management.

• From the talks on lung cancer, the main concepts that I learned were accurate staging strategy, pre-treatment patient selection and the choice of appropriate care.

This course deeply changed my medical practice on several topics. In the future, I will be more accurate in the diagnosis and the management of patients by focusing my medical decisions more on personalised medicine, using the course's support as an orientation to several references given during talks, and focusing on ERS monographs that are provided by the experts from different fields of respiratory medicine. The courses gave me more evidence-based knowledge and skills that are very useful for my medical practice.

My main messages to the ERS community: I want to thank you very much, and express my deep gratitude for all the efforts that you expend to facilitate access to this great knowledge for several respiratory actors. Your mission is both scientific and humanitarian because you give help to doctors who have less chance to access high-quality pre- and post-graduate medical education. So indirectly, you help their patients too. I encourage you to give us more live streaming courses so that more doctors who cannot attend those courses in person will be able to benefit from this huge educational opportunity. Medical simulation is an excellent way of learning that can be involved in many topics.

Thanh Huyền, Vietnam, a participant

This was my first time attending an ERS course along with participants from different countries. Initially, I was a little anxious about my English and about being unable to keep up with others, but after the first day, all my worries completely disappeared. I was immersed in the presentations of the highly experienced professors at the course. With a great deal of concentration on the matter in hand, the interactions made the course lively and professional. For me, a resident doctor preparing for my final examination, the ERS summer school this year – covering almost all topics – helped me to progressively acquire basic knowledge on the lung.

Since a lot of interesting topics were presented, it is really difficult for me to choose which topics I liked the most. In my opinion, in terms of improvement in medical practice, the most impressive presentation was the way to approach diagnosis of ILD. In fact, I have encountered a significant number of patients with ILD who were misdiagnosed with other lung diseases such as pneumonia or bronchiectasis, implying that ILDs remain a problem in our hospital practice. The limitations of our approach are that the diagnosis is based mostly on the clinical presentation and immune markers, and hardly on an appropriate interpretation of lung images. Fortunately, the course provided me with some valuable, novel insights into the approach to this complex group of lung diseases. Even more amazing was that I joined a workshop following the lecture on ILD that showed me how to interpret lesions on thoracic computed tomography scans. I hope that this change in my approach to ILDs after this course will contribute in the improvement of our daily medical practice.

Knowledge in medicine changes rapidly, so becoming a doctor means becoming a lifelong learner. This course gave me the opportunity to widen my knowledge and improve my practical skills in almost all the fields that I am interested in.

Overview from the faculty, Ernst Eber

The ERS Summer School of Paediatric Respiratory Medicine took place in June 2019 in Barcelona, Spain, and was the fifth Summer School organised by the ERS to provide a comprehensive update in paediatric respiratory medicine for professionals at all levels, based on the paediatric HERMES syllabus. The first summer school took place in Barcelona in 2015 and the courses since then were held annually, alternately in Barcelona and Lisbon.

So far, 285 participants (187, i.e. two thirds of them, female) have attended these courses. They came from all over the world, from six continents and 56 countries. Apart from Portugal and Spain as the venue countries, most of the participants came from Austria, Belgium, Germany, Greece, India, Italy, Norway, Switzerland, the Netherlands and the UK, with strikingly high attendance rates from countries with smaller populations. The majority of attendees defined themselves as clinicians, followed by paediatricians and clinical researchers, but general practitioners, physiotherapists/respiratory therapists and other professional categories were represented as well. More than half of them came from university hospitals, followed by nonuniversity hospitals and academic institutions; ∼10% of participants assigned themselves to “private/independent”.

The Summer School of Paediatric Respiratory Medicine is mainly targeted at the core group of clinicians, especially paediatric (respiratory) professionals wishing to update their knowledge, notably at those preparing for the European examination in paediatric respiratory medicine. This is reflected in the results of a survey, with more than half of the participants stating that their main motivation to attend was to update their knowledge in paediatric respiratory medicine and more than a third of the participants planning to sit the European examination in paediatric respiratory medicine in 2019 or later.

The programme is designed to challenge the participants by providing a learning framework with a balanced mixture of lectures, interactive sessions (workshops and case-based discussion sessions) and MCQ discussion sessions, the latter assisted by an interactive voting system.

Basant Kumar Shah, Nepal, a participant

The Summer School of Paediatric Respiratory Medicine 2019 was a well-organised course, covering most of the important aspects of paediatric respiratory medicine delivered by a highly motivated faculty. It was an excellent course and I really enjoyed the high-level lectures from the experts in the field. The summer school helped me to get updated on many important aspects of paediatric respiratory medicine within a short period of time. In addition, I gained insight into topics that were relatively new to me, such as sleep medicine and lung function testing, and I appreciated that the speakers also dealt with the situation in resource-limited settings. The workshops were particularly interesting and interactive, as they were done with small groups and included a wide variety of cases. There were also many opportunities to interact with the faculty during the breaks, and the speakers were very supportive and happy to share their views.

The atmosphere during the course was friendly and highly interactive, supported by the MCQs incorporated into each lecture. With participants coming from a variety of different countries, I learned a lot about the differences in practice and challenges faced by physicians in different medical settings.

After attending this course, I feel more confident in the field of paediatric respiratory medicine, and enabled to incorporate evidence-based medicine in my practice and make rational use of available resources for better management of patients. I highly recommend this course to all paediatricians interested in respiratory medicine as it provides a comprehensive and up-to-date review on the field. Congratulations to the organisers of this excellent course and many thanks to the ERS for providing me the opportunity to attend.

Oleksandr Mazulov, Ukraine, a participant

I had a strong wish to attend this summer school in order to gain up-to-date information in paediatric respiratory medicine. The quality of the programme more than met my expectations as all the main topics of paediatric respiratory medicine were covered by high quality lectures and workshops.

Although the schedule was quite tight, there were many opportunities for interaction between participants and faculty during the sessions and the breaks.

I found diagnostic methods such as pulmonary function testing and lung imaging particularly interesting. The workshops were based on interesting case presentations and were very interactive, especially the one on bronchoscopy, which was very helpful in increasing my understanding of paediatric respiratory conditions.

Further topics that were of particular interest to me included asthma and respiratory tract infections.

To sum up, the paediatric respiratory medicine summer school was an important step in my education and for my future work. I am really grateful to the course organisers – Prof. Ernst Eber, Prof. Monika Gappa and Prof. Fabio Midulla – for their great efforts with regard to this course, and to all faculty members for their comprehensive lectures and interesting discussions. I strongly encourage all ERS members who work in the field of paediatric pulmonology to take part in this Summer School.