Bronchoscopy simulator effectively prepares junior residents to competently perform basic clinical bronchoscopy

doi:10.1016/j.athoracsur.2003.11.058

The Annals of Thoracic Surgery

Volume 78, Issue 1, July 2004, Pages 287-291

Presented at the Thirty-ninth Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2003.

https://doi.org/10.1016/j.athoracsur.2003.11.058 Get rights and content

Abstract

Background

Teaching procedural skills in a clinical setting is becoming increasingly difficult. Simulators can provide safe and inexpensive skills training. This randomized study was conducted to evaluate the effectiveness of a bronchoscopy simulator in teaching clinical bronchoscopy.

Methods

Three groups of surgical residents were evaluated while performing an intraoperative flexible bronchoscopy. First year (PGY1) residents were randomly assigned to perform bronchoscopy either with (n = 5) or without (n = 5) preprocedural bronchoscopic simulator training (PreOp flexible bronchoscopic simulator, Immersion Medical, Gaithersburg, MD). Residents PGY2 to 3 (n = 3) with prior bronchoscopic experience (≥ 10 bronchoscopies) underwent evaluation without simulator training. Subjects were required to complete a systematic airway examination through a laryngeal mask airway with patients under general anesthesia. Evaluation criteria included procedure time, number of verbal and physical interventions by evaluator, and a rating of exam thoroughness, proficiency, and confidence.

Results

The PGY1 subjects who trained on the simulator required significantly fewer verbal (6.2 ± 1.6 vs 3.2 ± 0.8) and physical (1.6 ± 0.2 vs 0.2 ± 0.4) cues and performed more systematic examinations (2.6 ± 0.5 vs 4.4 ± 0.9 on scale 1 to 5) than those who did not use the trainer. The skill level of PGY1 subjects who worked with the simulator was similar to that of PGY2 to 3 residents experienced in bronchoscopy. Procedural times were not different between groups as the evaluator maintained the pace of the examination using verbal and physical assistance.

Conclusions

One hour of training with the bronchoscopic simulator effectively taught residents basic bronchoscopy and familiarity with airway anatomy. Residents using the trainer performed first-time bronchoscopy nearly as competently as residents experienced with bronchoscopy.

Section snippets

Material and methods

First year general surgery and preliminary residents (PGY1) and second and third year (PGY2 and PGY3) general surgery residents rotating through the thoracic surgery service were eligible to enter the study. A total of thirteen residents, divided into three groups, participated: Naïve PGY1 residents with no bronchoscopy training (n = 5); trained PGY1 residents after bronchoscopy simulator training (n = 5); experienced PGY2 to 3 residents with previous bronchoscopic experience (n = 3).

All PGY 1

Results

Participants in the training group all completed the basic anatomy model and at least one patient simulation. The average number of patient simulations completed was 3.8. The amount of time spent with the simulator averaged 60 minutes.

The numbers of endoscopic and bronchoscopic procedures observed and performed were no different between the naïve and trained groups. (Table 1) The experienced group had all done ten or more bronchoscopies before evaluation.

Times to completion of bronchoscopy were

Comment

Bronchoscopy is a basic skill that all surgical residents should master early in training. Intraoperative bronchoscopy before thoracic procedures provides an ideal opportunity for residents to learn bronchoscopic techniques. We found that even one hour of work with the simulator dramatically improved the ability of junior residents to perform bronchoscopy. This allowed them to concentrate on relevant pathology and anatomy during their intraoperative bronchoscopy.

This study was only intended to

Acknowledgements

The simulator was purchased by funds donated to the NIMIST laboratory from the United States Surgical Corp.

References (4)

R.C Bone
(American College of Chest Physicians, Section on Bronchoscopy). Guidelines for competency and training in fiberoptic bronchoscopy
Chest
(1982)
H.G Colt et al.
Virtual reality bronchoscopy simulationa revolution in procedural training
Chest
(2001)

There are more references available in the full text version of this article.

Cited by (147)

Effectiveness of Flexible Bronchoscopy Simulation-Based Training: A Systematic Review
2023, Chest
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, considering all available literature until November 10, 2022. We assessed methodological quality of included studies using a modified version of the Medical Education Research Study Quality Instrument, 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 most of their outcome measures. However, risk of bias was moderate or high in eight studies, and only six studies were of high quality (modified Medical Education Research Study Quality Instrument score ≥ 12.5). Moreover, instructional features and outcome measures varied highly across studies, and only four studies evaluated intervention effects on behavioral outcome measures in the patient setting. All of the simulation training programs in studies with the highest methodological quality and most relevant outcome measures included curriculum integration and a 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 because of heterogeneity of training features and the sparse evidence of training effectiveness on validated behavioral outcome measures in a patient setting.
PROSPERO; No.: CRD42021262853; URL: https://www.crd.york.ac.uk/prospero/
Short-Term Retention of Patient and Caregiver Ventricular Assist Device Self-Care Skills After Simulation-Based Mastery Learning
2021, Clinical Simulation in Nursing
We developed a simulation-based mastery learning (SBML) curriculum that boosted self-care skills for patients with a ventricular assist device (VAD). In this study, we evaluated short-term skills retention.
We assessed skill retention among patients and caregivers who participated in VAD self-care SBML at a tertiary care center. We compared discharge skills tests (immediately after completing SBML) with 1- and 3-month follow-up tests to assess skill retention.
Fifteen patients and 15 caregivers completed discharge and follow-up testing. Skills were largely retained at 1 and 3 months.
SBML results in short-term retention of VAD self-care skills.
Climbing the Mountain: Value of Simulation in Interventional Radiology Training
2019, Techniques in Vascular and Interventional Radiology
A Randomized Controlled Trial of Skills Transfer: From Touch Surgery to Laparoscopic Cholecystectomy
2019, Journal of Surgical Research
Surgical training has traditionally involved teaching trainees in the operating room. However, intraoperative training is time-intensive and exposes patients to greater risks. Touch Surgery (TS) is an application that uses animation to provide simulation training via cognitive task analysis as an adjunct to intraoperative training.
Forty students were recruited and randomly allocated to either a control or intervention group. Each group received the same preparation before intervention, including a 10-min introduction to laparoscopic equipment and a 15-min educational tutorial on laparoscopic cholecystectomies. The participants then received training via either TS (intervention) or written information (control). Their performance was compared using a validated scoring tool on a porcine laparoscopic cholecystectomy model. Significance was defined as P < 0.050.
In total, n = 22 and n = 18 participants were randomly assigned to intervention and control groups, respectively. There was no significant difference between age (P = 0.320), year of medical school (P = 0.322), handedness (P = 1.000), or gender (P = 0.360) of the groups. The overall mean performance score was higher for intervention (mean ± SD = 41.9 ± 22.5) than control (mean ± SD = 24.7 ± 19.6; P = 0.016). There was no significant difference between scores for each intraoperative segment between the intervention and control group (P > 0.050).
This study demonstrates that TS is effective for providing cognitive training in laparoscopic cholecystectomies to medical students. It is likely that this effect will be seen across modules and other platforms that use cognitive task analysis alongside high-fidelity animation. Further work is necessary to extend this to other surgical procedures for evaluating its longitudinal effectiveness.
Scenario-based simulation health care education for performance of hand hygiene
2019, American Journal of Infection Control
Simulation health care education is widely used in medical education and has great potential. However, scenario-based simulation health care education for preventing health care–associated infections has not been described.
A single-center, prospective cohort study was conducted at Tokyo Medical University Hospital (1,015 beds), an acute care teaching hospital, from January 2011 to December 2014. Each training course was held every month and lasted 2 hours. Trainees put on and removed personal protective equipment under scenarios of standard precaution (2 scenarios) and contact precaution with methicillin-resistant Staphylococcus aureus (1 scenario), while considering the timing of hand hygiene. We determined the correlations between the participation rate in the simulation education and the use of alcohol-based hand disinfection and reduction of catheter-related bloodstream infection.
There were 1,077 trainees. The total participation rate for hospital staff, which increased gradually during the study period, was 76% by the end of the study. The overall correlation between the use of alcohol-based hand disinfection in the hospital and the course participation rate was significant (correlation coefficient, 0.97). An inverse correlation (−0.94) was observed for the relation between the training course participation rate and the incidence of catheter-related bloodstream infection.
Our training course had a positive effect on hand hygiene. This study is the first effective scenario-based simulation health care education on hand hygiene and control of health care–associated infection.
A Clinical Study on Video Bronchoscopy-guided Coblation for Benign Central Airway Stenosis
2024, Ear, Nose and Throat Journal

View all citing articles on Scopus

View full text

Original article: general thoracicBronchoscopy simulator effectively prepares junior residents to competently perform basic clinical bronchoscopy

Abstract

Background

Methods

Results

Conclusions

Section snippets

Material and methods

Results

Comment

Acknowledgements

Chest

Chest

Original article: general thoracic
Bronchoscopy simulator effectively prepares junior residents to competently perform basic clinical bronchoscopy