Building the Future of Interventional Pulmonology: Reflections from the Forum of La Gomera

Interventional pulmonology (IP) has undergone a profound transformation over the past decades, evolving from an emerging procedural skill set into a mature, high-complexity subspecialty with substantial clinical impact. Its consolidation has been driven by technological innovation, expanding therapeutic possibilities, and the growing need to address oncological, pleural, and airway diseases with minimally invasive approaches.^1–4 Yet despite this progress, IP in Spain continues to face structural challenges that limit its full integration and recognition within the healthcare system.^5,6

The Forum of La Gomera was conceived as an independent, clinician-driven initiative promoted by a group of senior and mid-career interventional pulmonologists from different Spanish institutions, aiming to create a protected space for strategic reflection outside formal society or industry frameworks. The rationale for organizing the Forum stemmed from the need to collectively analyze the current state of IP in Spain and define shared priorities for its future development. Participants were invited based on their clinical experience, academic involvement, leadership roles, and generational and institutional representation, ensuring a plural, multidisciplinary, and independent perspective.

In this context, the Forum of La Gomera, held in October 2025, represents a milestone for Spanish IP. For the first time, specialists from different generations, institutions, and professional backgrounds gathered in an independent, intensive 72-h retreat to reflect on the present and future of the subspecialty.^7,8 The meeting adopted a “Davos-style” structured debate format, with timed sessions and a systematic methodology designed to promote open dialogue, constructive disagreement, and consensus-oriented thinking.^7,8 The result was a forward-looking and pragmatic vision intended to guide the strategic evolution of IP in Spain.

The discussions highlighted several long-standing gaps. Training remains heterogeneous and heavily dependent on individual mentorship, in contrast with the standardized fellowship programs established in the United States and Canada, as well as in several European countries.⁶ Research efforts are fragmented, lacking the multicenter registries and organizational support needed to generate robust evidence and strengthen scientific leadership.⁹ Technological advances – particularly artificial intelligence – pose exciting opportunities, yet their successful integration requires ethical frameworks, clinical validation, and adequate digital infrastructure.¹⁰ Furthermore, the unequal distribution of complex procedures across the country underscores the need for reference units and structured referral pathways to ensure equity and quality of care.

From these reflections, the Forum reached a consensus on seven strategic priorities for the advancement of IP in Spain.

Institutional management

IP must strengthen its position within hospitals through units with functional autonomy, resources proportional to healthcare activity, and active participation in multidisciplinary committees, especially in thoracic oncology.

Standardization of training

Updating the MIR program – the national postgraduate medical training system in Spain – would allow the incorporation of specific competencies in Interventional Pulmonology, ensuring homogeneous, high-quality exposure to diagnostic and therapeutic techniques during specialist training. The objective of this update is to reduce variability in training, guarantee minimum procedural experience, and facilitate continuity toward advanced IP practice.

Similarly, it is necessary to promote standardized national competencies and structured fellowship programs.

In this context, the term “training centers” refers both to MIR-accredited hospitals providing core pulmonology training and to accredited centers offering post-residency fellowship programs in IP, each with clearly defined roles and requirements.

Research

Priority should be given to the creation of multicenter national registries, the incorporation of project managers, and active participation in international studies to strengthen the scientific evidence base and the international leadership of Spanish IP.

Relationship with industry

Collaboration with the technology industry must be structured within an ethical and transparent framework, ensuring the clinical validation of innovations, accredited training, and the active participation of clinicians in the development of medical devices.

Artificial intelligence

New tools, such as artificial intelligence, must be integrated into procedure planning, data management, and teaching. Rigorous medical supervision is required to ensure clinical applicability, safety, and ethical use.

Centralization and reference units

The creation of reference units will allow for the centralization of highly complex techniques, with structured referral systems, thus promoting efficiency, equity, and quality of care.

This proposal is aligned with and complementary to the existing accreditation model of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), which defines different levels of complexity (basic, specialized, and high complexity) for IP units. The Forum of La Gomera supports this framework and advocates for its integration into broader strategic planning, particularly regarding referral pathways, training capacity, and recognition of centers meeting excellence criteria.

Solidarity projects and international cooperation

IP should promote international cooperation projects, technology transfer, and professional training in resource-limited settings, reinforcing its social commitment and expanding the global impact of the discipline.

Regarding implementation, the Forum of La Gomera is intended as a living initiative rather than a single-event consensus. Its conclusions will be disseminated through scientific publications, presentations in national and international meetings, and dialogue with professional societies and healthcare stakeholders.

The Forum participants expressed the intention to establish periodic follow-up meetings to reassess progress, update strategic priorities, and adapt recommendations according to scientific, technological, and organizational advances in the field.

The consensus reached, known as the Forum of La Gomera, is supported by recent literature and provides a flexible, solid, and open framework for action, aimed at consolidating a cohesive, modern, and internationally recognized IP.^1–10 Its progressive implementation will enable continuous improvement in the quality of care and the optimization of specialized resources.

Declaration of generative AI and AI-assisted technologies in the writing process

The manuscript is an original work written by the authors. It has been reviewed using AI for literary correction in some paragraphs, but this has not affected the content.

Funding

This publication has been produced without any funding or support.

Authors’ contributions

J.F. conceived and designed the study and critically revised the manuscript. B.F.V. contributed to the literature review and drafting of the initial manuscript. All authors participated in the discussion of the results, reviewed the manuscript, approved the final submitted version, and take responsibility for its content.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Acknowledgments

This consensus was made possible thanks to the participation of: Dra. Marisol Arenas de Larriva (Hospital Universitario Reina Sofía, Córdoba), Dr. Enrique Cases Viedma (Hospital Universitario La Fe, Valencia), Dr. Carlos Disdier Vicente (Hospital Clínico Universitario, Valladolid), Dra. Luisa Eiroa González (Hospital Universitario Nuestra Señora de la Candelaria, Tenerife), Dra. Blanca de Vega Sánchez (Hospital Clínico Universitario, Valladolid), Dr. Javier Flandes (Hospital Fundación Jiménez Díaz. IIS-FJD, CIBERES, Madrid), Dr. Lorenzo Pérez Negrín (Hospital Universitario Nuestra Señora de la Candelaria, Tenerife), Dr. Borja Recalde (Hospital Fundación Jiménez Díaz. IIS-FJD, CIBERES, Madrid) and Dr. Aurelio Wangüemert Pérez (Hospital San Juan de Dios, Tenerife).