A Low-Cost Bio-Simulator and Single Use or EBUS Bronchoscopy. A Platform for Remote Training.

Abstract

The Covid-19 pandemic has resulted in reconsideration of our traditional teaching modalities and develop newer, dynamic methods. Both high and low fidelity simulators in bronchoscopy are costly. To assess whether a combination of a low-cost bio-simulator made of recyclable materials (ALFIE^TM Airway Low Fidelity including EBUS (endobronchial ultrasound)) and single use flexible bronchoscopy (SUFB) or EBUS scope has the capability of differentiating novices from experts and the ability to train novices in bronchoscopy. Trainees were evaluated individually before and after training using a modified validated Bronchoscopy Skills and Tasks Assessment Tool (B-STAT) and SUFB. In a similar fashion, another cohort were tested using an EBUS scope and a modified validated EBUS score (EBUS-STAT). 18 trainees were included (14 residents and 4 fellows) in the ALFIE^TM-SUFB assessment and 19 (11 residents and 8 fellows) in ALFIE^TM-EBUS assessment. Pre-training assessment of scope handling differentiated novices from experienced bronchoscopists (SUFB p=0.0025 (95% confidence intervals (CI) 3.12-12.17); EBUS p=0.0005 (95% confidence intervals 1.3-2.95)). Training of novices was associated with an improvement in scope handling and sampling (SUFB p=0.0001 (95% CI 4.73-10.27); EBUS p=0.0011 (95% confidence intervals 0.41-1.22)). Significant improvements in EBUS-TBNA score (p=0.0011 (n=7, 95% confidence intervals 0.35-5.09)) and total EBUS score (p=0.0472 (95% confidence intervals 0.03-1.4.65)) were identified in fellows. ALFIE^TM and EBUS combination could assist in low cost training of EBUS-TBNA. ALFIE^TM and SUFB has the potential to create a low-cost platform to teach bronchoscopy remotely.