Stylianos Loukides1, Gabor Kovacs2, Kada Bentata3, Thanh Huyền4, Basant Kumar Shah5,

Oleksandr Mazulov6, Ernst Eber7

[email protected]

Course report
Summer schools of adult
and paediatric respiratory
medicine: course report
Summer school of adult tests and imaging. The course represents an ideal Cite as: Loukides S, Kovacs G,
Bentata K, et al. Summer
tool for the preparation for the HERMES diploma.
respiratory medicine The course held in June 2019 was the eighth schools of adult and paediatric
of its kind; the first summer school took place in respiratory medicine: course
Faculty: G. Burns, U. Costabel, M.L. De Souza report. Breathe 2020; 16:
Barcelona, Spain, back in 2012. Ever since, the
190305.
Galvao, W. De Wever, M. Ferrer Monreal, R.M. summer school has taken place five more times
Huber, G. Kovacs, S. Loukides, L. Pisani, E. in Barcelona and twice in Lisbon, Portugal (2016
Polverino, N.M. Rahman, N. Regamey, S.E. Schiza and 2018). There have been 438 Summer School
participants altogether, coming from 58 countries.
The 4-day course is set up for respiratory
Overview from the faculty, physicians who have already finished their training
or are in their final year. The content of the sessions
Stylianos Loukides
and the educational material are mainly based on
and Gabor Kovacs guidelines and position papers reflecting evidence-
The European Respiratory Society (ERS) has a based medicine. The experts also challenge the
long tradition of organising major congresses and participants with a multiple-choice questionnaire
courses in various areas of respiratory medicine (MCQ) after each presentation in order to test their
in order to share knowledge and promote clinical knowledge.
education. The courses are led by respiratory We organisers hope that participants of the
specialists committed to the ERS and having summer school had the opportunity to meet experts
great experience in the field. One of the most and colleagues from other countries widening their
important courses is the ERS Summer School of knowledge in respiratory medicine. We also hope
Adult Respiratory Medicine. This particular course that by the end of the course, they became more
aims to provide a detailed overview of up-to- familiar with current clinical guidelines and took
date, established clinical knowledge, mainly for home practical knowledge that they use in their
early career respiratory physicians. It discusses daily work.
the most important questions of respiratory After the summer school this year, several
medicine, including obstructive airway diseases, colleagues participated at the HERMES self-
respiratory infections, tuberculosis, cystic fibrosis, assessment course. This gave the opportunity to
bronchiectasis, lung cancer, mesothelioma, pleural sit the shortened version of the HERMES exam,
diseases, sleep disorders, vascular diseases, including 30 MCQ questions. At the end of the
interstitial lung diseases, sarcoidosis, lung function examination, all questions were discussed.

@ERSpublications
The @EuroRespSoc summers schools of adult and paediatric respiratory medicine took place on
June 12–15, 2019, in Barcelona, Spain http://bit.ly/38VPAc5

https://doi.org/10.1183/20734735.0305-2019Breathe 
| March 2020 | Volume 16 | No 1 1
 Summer schools of adult and paediatric respiratory medicine

We organisers believe that this was a good ●● The talk about ILD, and the imaging conference
experience for colleagues planning to apply for the and workshop, were very helpful to narrow the
HERMES exam at the ERS Congress. They could diagnosis of ILDs, which are very complicated in
test their knowledge and received feedback from our medical practice, so we can improve their
the faculty. As the current session revealed, some management.
candidates were very well prepared already and ●● From the talks on lung cancer, the main concepts
would have a good chance to pass the real exam. that I learned were accurate staging strategy,
We hope that, as at each of the previous summer pre-treatment patient selection and the choice
schools, this year, we could provide participants of appropriate care.
with up-to-date, evidence-based clinical knowledge,
we were able to share a professional and practical This course deeply changed my medical practice
way of medical thinking, and we could represent on several topics. In the future, I will be more
the values of the ERS. We believe that colleagues accurate in the diagnosis and the management of
from all countries who participated in these patients by focusing my medical decisions more on
high-level educational courses and successfully personalised medicine, using the course’s support
prepared for the HERMES exam fulfil the highest as an orientation to several references given during
European educational standards, and may form talks, and focusing on ERS monographs that are
a core of respiratory physicians taking increasing provided by the experts from different fields of
responsibility in our society in the future. respiratory medicine. The courses gave me more
evidence-based knowledge and skills that are very
useful for my medical practice.
Kada Bentata, Algeria, My main messages to the ERS community:
a participant I want to thank you very much, and express my
deep gratitude for all the efforts that you expend to
When arriving at the course, I was quite worried facilitate access to this great knowledge for several
about the atmosphere because it was my first respiratory actors. Your mission is both scientific
participation in such a course. However, after the and humanitarian because you give help to doctors
first contact with the ERS team – who were very who have less chance to access high-quality pre-
professional and friendly – I was very confident and post-graduate medical education. So indirectly,
and relaxed, and my appetite for knowledge was you help their patients too. I encourage you to
whetted. The course had an intimate atmosphere, give us more live streaming courses so that more
with great knowledge and skills provided by doctors who cannot attend those courses in person
international experts in the field. I was like a person will be able to benefit from this huge educational
lost in the desert who finally finds an oasis. There opportunity. Medical simulation is an excellent way
was excellent organisation with a constructive of learning that can be involved in many topics.
atmosphere.
All topics were interesting and very well presented
by the faculty. Of course, some topics appeared
even more attractive than others. For example, Thanh Huyền, Vietnam,
asthma, COPD and obstructive sleep apnoea were a participant
especially interesting due to the frequency of these
This was my first time attending an ERS course
diseases and the new emerging treatments. Pleural
along with participants from different countries.
diseases, very well exposed by Prof. Rahman, were
Initially, I was a little anxious about my English
interesting due to the availability of new diagnostic
and about being unable to keep up with others,
and treatment tools to facilitate the management of
but after the first day, all my worries completely
the disease. Lung cancer was presented very well by
disappeared. I was immersed in the presentations
Prof. Huber, who has great experience in the field.
of the highly experienced professors at the course.
Lung imaging was a very interesting topic too and
With a great deal of concentration on the matter in
its implications in the management of most lung
hand, the interactions made the course lively and
diseases were clearly highlighted.
professional. For me, a resident doctor preparing
I learned so much from this course. The main
for my final examination, the ERS summer school
concepts that were very useful for me regarding
this year – covering almost all topics – helped me to
my daily practice concern the pleural diseases,
progressively acquire basic knowledge on the lung.
lung cancer, sleep apnoea and interstitial lung
Since a lot of interesting topics were presented, it
diseases (ILD).
is really difficult for me to choose which topics I liked
the most. In my opinion, in terms of improvement in
●● In pleural diseases, I learned some new tools medical practice, the most impressive presentation
to improve my diagnostic strategy for pleural was the way to approach diagnosis of ILD. In fact, I
effusion, especially malignant and infectious ones. have encountered a significant number of patients
●● In sleep apnoea, the talk and the workshop were with ILD who were misdiagnosed with other lung
very useful, and helped me to manage some diseases such as pneumonia or bronchiectasis,
cases of this disease. implying that ILDs remain a problem in our hospital

2 Breathe  | March 2020 | Volume 16 | No 1

practice. The limitations of our approach are that professionals wishing to update their knowledge,
the diagnosis is based mostly on the clinical notably at those preparing for the European
presentation and immune markers, and hardly examination in paediatric respiratory medicine. This
on an appropriate interpretation of lung images. is reflected in the results of a survey, with more
Fortunately, the course provided me with some than half of the participants stating that their main
valuable, novel insights into the approach to this motivation to attend was to update their knowledge
complex group of lung diseases. Even more amazing in paediatric respiratory medicine and more than a
was that I joined a workshop following the lecture third of the participants planning to sit the European
on ILD that showed me how to interpret lesions examination in paediatric respiratory medicine in
on thoracic computed tomography scans. I hope 2019 or later.
that this change in my approach to ILDs after this The programme is designed to challenge the
course will contribute in the improvement of our participants by providing a learning framework with
daily medical practice. a balanced mixture of lectures, interactive sessions
Knowledge in medicine changes rapidly, so (workshops and case-based discussion sessions)
becoming a doctor means becoming a lifelong and MCQ discussion sessions, the latter assisted
learner. This course gave me the opportunity to by an interactive voting system.
widen my knowledge and improve my practical
skills in almost all the fields that I am interested in.
Educational aims
During the course, participants gained detailed
Summer school of paediatric knowledge of:
respiratory medicine ●● Major fields of paediatric respiratory medicine
●● Best practice in how to prepare for the European
Faculty: E. Eber, M. Gappa, F. Midulla, M. Beer, examination in paediatric respiratory medicine
R. Ersu, A. Hadchouel-Duvergé, I. Monedero, ●● How to answer MCQ questions
M. Pijnenburg, N. Regamey
The 3.5-day course was spread across 4 days,
from Wednesday morning to Saturday midday,
Overview from the followed by a separately booked ERS HERMES
self-assessment course in paediatric respiratory
faculty, Ernst Eber
medicine consisting of a simulated HERMES
The ERS Summer School of Paediatric Respiratory examination, and a subsequent feedback and
Medicine took place in June 2019 in Barcelona, discussion of examination questions part.
Spain, and was the fifth Summer School organised Topics covered in the summer school included:
by the ERS to provide a comprehensive update in
paediatric respiratory medicine for professionals at ●● Acute and chronic respiratory infections
all levels, based on the paediatric HERMES syllabus. ●● Airway endoscopy
The first summer school took place in Barcelona ●● Bronchial asthma and wheezing disorders
in 2015 and the courses since then were held ●● Chronic respiratory failure
annually, alternately in Barcelona and Lisbon. ●● Congenital malformations
So far, 285 participants (187, i.e. two thirds of ●● Cystic fibrosis
them, female) have attended these courses. They ●● Evaluation of respiratory signs and symptoms
came from all over the world, from six continents ●● Lung function testing
and 56 countries. Apart from Portugal and Spain as ●● Lung imaging
the venue countries, most of the participants came ●● Rare diseases and lung transplantation
from Austria, Belgium, Germany, Greece, India, ●● Rehabilitation in chronic respiratory disorders
Italy, Norway, Switzerland, the Netherlands and ●● Sleep medicine
the UK, with strikingly high attendance rates from ●● Technology-dependent children
countries with smaller populations. The majority of ●● Tuberculosis
attendees defined themselves as clinicians, followed
by paediatricians and clinical researchers, but The course was again excellently organised
general practitioners, physiotherapists/respiratory by ERS staff, before and during the course itself.
therapists and other professional categories were Participants were provided with materials prior to
represented as well. More than half of them came the course, including information on topics that
from university hospitals, followed by nonuniversity could not be covered during the course due to
hospitals and academic institutions; ∼10% of shortage of time, for the sake of accommodating
participants assigned themselves to “private/ rounds of workshops and interactive, case-based
independent”. discussion sessions.
The Summer School of Paediatric Respiratory One of the main challenges was to prepare
Medicine is mainly targeted at the core group the lectures at the right level, as the level of
of clinicians, especially paediatric (respiratory) knowledge of the participants varied widely, similar

Breathe  | March 2020 | Volume 16 | No 1 3

to previous summer schools. A further challenge relatively new to me, such as sleep medicine and
was the variable background of the attendees both lung function testing, and I appreciated that the
regarding knowledge, and to countries of origin and speakers also dealt with the situation in resource-
healthcare systems. Thus, depending on their level limited settings. The workshops were particularly
of knowledge and experience, some participants interesting and interactive, as they were done with
apparently felt that some of the lectures were quite small groups and included a wide variety of cases.
challenging. There were also many opportunities to interact with
As in previous years, many of the participants the faculty during the breaks, and the speakers were
wanted to learn about diagnostic testing in very supportive and happy to share their views.
paediatric respiratory medicine (e.g. when to The atmosphere during the course was friendly
apply, how to perform and how to interpret airway and highly interactive, supported by the MCQs
endoscopy, and lung function testing). In addition, incorporated into each lecture. With participants
a substantial subgroup was particularly keen coming from a variety of different countries, I
to learn about rare disorders such as congenital learned a lot about the differences in practice and
malformations and rare diseases such as cystic challenges faced by physicians in different medical
fibrosis and primary ciliary dyskinesia. settings.
The interactive sessions (four rounds of four After attending this course, I feel more confident
workshops and five case-based discussions) are in the field of paediatric respiratory medicine, and
a huge asset to the course. Again this year, the enabled to incorporate evidence-based medicine
attendees were very keen to present their own cases in my practice and make rational use of available
and discuss them with the whole group, in particular resources for better management of patients. I
with the faculty. In addition, the workshops were highly recommend this course to all paediatricians
very well received, and the interaction between the interested in respiratory medicine as it provides a
participants and the faculty was very good. Lively comprehensive and up-to-date review on the field.
discussions went on during the breaks, and most Congratulations to the organisers of this excellent
of the group obviously very much enjoyed the course and many thanks to the ERS for providing
exchange of knowledge and thoughts. me the opportunity to attend.
Relevant (new) topics for future summer schools
could be a more comprehensive discussion of rare
(genetic) disorders and providing more information Oleksandr Mazulov,
on technology-dependent children. In addition, the Ukraine, a participant
faculty felt that additional skills courses in lung
I had a strong wish to attend this summer school in
function and allergy testing, and lung ultrasound
order to gain up-to-date information in paediatric
might be an idea to pursue.
respiratory medicine. The quality of the programme
In summary, this fifth Summer School in
more than met my expectations as all the main
Paediatric Respiratory Medicine was a huge success,
topics of paediatric respiratory medicine were
and this unique opportunity for participants from
covered by high quality lectures and workshops.
many countries to come together for 4 days to
Although the schedule was quite tight, there
learn not only from experienced faculty but also
were many opportunities for interaction between
from each other, should certainly be continued
participants and faculty during the sessions and
annually. The personal feedback received from
the breaks.
participants during the course underlined the need
I found diagnostic methods such as pulmonary
for this educational ERS activity. We will keep and
function testing and lung imaging particularly
build on the interactive components of this course
interesting. The workshops were based on
to leave participants with new knowledge and
interesting case presentations and were very
understanding of, and enthusiasm for paediatric
interactive, especially the one on bronchoscopy,
respiratory medicine.
which was very helpful in increasing my
understanding of paediatric respiratory conditions.
Basant Kumar Shah, Further topics that were of particular interest to
me included asthma and respiratory tract infections.
Nepal, a participant
To sum up, the paediatric respiratory medicine
The Summer School of Paediatric Respiratory summer school was an important step in my
Medicine 2019 was a well-organised course, education and for my future work. I am really
covering most of the important aspects of paediatric grateful to the course organisers – Prof. Ernst Eber,
respiratory medicine delivered by a highly motivated Prof. Monika Gappa and Prof. Fabio Midulla – for
faculty. It was an excellent course and I really their great efforts with regard to this course, and
enjoyed the high-level lectures from the experts to all faculty members for their comprehensive
in the field. The summer school helped me to get lectures and interesting discussions. I strongly
updated on many important aspects of paediatric encourage all ERS members who work in the field of
respiratory medicine within a short period of time. paediatric pulmonology to take part in this Summer
In addition, I gained insight into topics that were School.

4 Breathe  | March 2020 | Volume 16 | No 1

Affiliations

Stylianos Loukides1, Gabor Kovacs2, Kada Bentata3, Thanh Huyền4, Basant Kumar Shah5,
Oleksandr Mazulov6, Ernst Eber7
1National and Kapodistrian University of Athens, Medical School, 2nd Respiratory Medicine Dept, Athens, Greece.
2Medical University of Graz and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria. 3Medical
Faculty and Hospital of Mostaganem, Mostaganem, Algeria. 4University of Medicine and Pharmacy of Ho Chi
Minh City, Pulmonary Department, Chợ Rẫy Hospital, Ho Chi Minh City, Vietnam. 5Patan Hospital, Lalitpur, Nepal.
6National Pirogov Medical University, Vinnytsya Children’s Regional Hospital, Pulmonology Dept, Vinnytsya,

Ukraine. 7Division of Paediatric Pulmonology and Allergology, Dept of Paediatrics and Adolescent Medicine, Medical
University of Graz, Graz, Austria.

Conflict of interest:

S. Loukides has nothing to disclose. G. Kovacs reports personal fees and nonfinancial support from Actelion, Bayer,
GSK, MSD, Boehringer Ingelheim, Novartis, Chiesi and Vitalaire outside the submitted work. K. Bentata has nothing
to disclose. T. Thanh Huyền has nothing to disclose. K. Shah has nothing to disclose. O. Mazulov has nothing to
disclose. E. Eber has nothing to disclose.

Breathe  | March 2020 | Volume 16 | No 1 5