Abstract
BackgroundWe sought to determine whether a self-training program on a high-fidelity flexible bronchoscopy (FB) simulator would allow residents who were novices in bronchoscopy to acquire competencies similar to those of experienced bronchoscopists as concerns the visualization of the bronchial tree and the identification of its anatomical elements.MethodsWe performed a prospective cohort study, categorizing bronchoscopists into three groups according to their experience level: novice (Group A, no FBs performed, n = 8), moderate (Group B, 30 ≤ FBs performed ≤200, n = 17) or high (Group C, > 200 FBs performed, n = 9). All were initially evaluated on their ability to perform on a high-fidelity FB simulator a complete visualization/identification of the bronchial tree in the least amount of time possible. The residents in Group A then completed a simulation-based self-training program and underwent a final evaluation thereafter.ResultsThe median total procedure time for Group A fell from 561 s (IQR = 134) in the initial evaluation to 216 s (IQR = 257) in the final evaluation (P = 0.002). The visualization and identification scores for Group A also improved significantly in the final evaluation. Resultantly, the overall performance score for Group A climbed from 5.9% (IQR = 5.1) before self-training to 25.5% (IQR = 26.3) after (P = 0.002), thus becoming comparable to the overall performance scores of Group B (25.3%, IQR = 13.8) and Group C (22.2%, IQR = 5.5).ConclusionsNovice bronchoscopists who self-train on a high-fidelity simulator acquire basic competencies similar to those of moderately or even highly experienced bronchoscopists. High-fidelity simulation should be rapidly integrated within the learning curriculum and replace traditional, in-patient learning methods.
Highlights
We sought to determine whether a self-training program on a high-fidelity flexible bronchoscopy (FB) simulator would allow residents who were novices in bronchoscopy to acquire competencies similar to those of experienced bronchoscopists as concerns the visualization of the bronchial tree and the identification of its anatomical elements
Study type and objectives The primary objective of this prospective cohort study, carried out between October 2015 and September 2016, was to assess FB skill acquisition in novice bronchoscopists who self-trained on a high-fidelity bronchoscopy simulator (Simbionix Bronch Mentor), and compare their skills to those of moderately and highly experienced bronchoscopists (Additional file 1: Table S1)
We found no significant difference in the overall performance score between participants who dropped-out the program and those who complete it (7.99 [IQR1.9] vs. 5.93 [interquartile ranges (IQR) 5.1]; p = 0.290)
Summary
We sought to determine whether a self-training program on a high-fidelity flexible bronchoscopy (FB) simulator would allow residents who were novices in bronchoscopy to acquire competencies similar to those of experienced bronchoscopists as concerns the visualization of the bronchial tree and the identification of its anatomical elements. Several methods of bronchoscopy simulation have been developed and studied These include animal models [7,8,9], low-fidelity trainers [10,11,12,13,14,15], and, since the early 2000s, high-fidelity virtual-reality simulators [16,17,18,19,20]. Many of the studies included in that meta-analysis were performed in the settings of otolaryngology or anesthesiology. Bronchoscopy in those fields is relatively simple; it does not involve detailed visualization of the bronchial tree as is the case in pulmonology
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