Effectiveness of Flexible Bronchoscopy Simulation-Based Training: A Systematic Review

Abstract

The implementation of simulation-based training (SBT) to teach flexible bronchoscopy (FB) skills to novice trainees has increased during the last decade. However, it is unknown whether SBT is effective to teach FB to novices and which instructional features contribute to training effectiveness. How effective is FB SBT and which instructional features contribute to training effectiveness? We searched Embase, Pubmed, Scopus and Web of Science for articles on FB SBT for novice trainees until November 10, 2022. We assessed methodological quality of included studies using a modified version of the Medical Education Research Study Quality Instrument (MERSQI), evaluated risk of bias with relevant tools depending on study design, assessed instructional features and intended to correlate instructional features to outcome measures. We identified 14 studies from an initial pool of 544 studies. Eleven studies reported positive effects of FB SBT on the majority of their outcome measures. However, risk of bias was moderate or high in 8 studies and only 6 studies were of high quality (modified MERSQI score ≥ 12.5). Moreover, instructional features and outcome measures varied highly across studies and only 4 studies evaluated intervention effects on behavioral outcome measures in the patient setting. Simulation training programs in studies with the highest methodological quality and most relevant outcome measures all included curriculum integration and range in task difficulty. Although most studies reported positive effects of simulation training programs on their outcome measures, definitive conclusions regarding training effectiveness on actual bronchoscopy performance in patients could not be made, due to heterogeneity of training features and the sparse evidence of training effectiveness on validated behavioral outcome measures in a patient setting.