Chest
Volume 120, Issue 4, October 2001, Pages 1333-1339
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Bronchoscopy
Virtual Reality Bronchoscopy Simulation: A Revolution in Procedural Training

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Background

In the airline industry, training is costly and operator error must be avoided. Therefore, virtual reality (VR) is routinely used to learn manual and technical skills through simulation before pilots assume flight responsibilities. In the field of medicine, manual and technical skills must also be acquired to competently perform invasive procedures such as flexible fiberoptic bronchoscopy (FFB). Until recently, training in FFB and other endoscopic procedures has occurred on the job in real patients. We hypothesized that novice trainees using a VR skill center could rapidly acquire basic skills, and that results would compare favorably with those of senior trainees trained in the conventional manner.

Methods

We prospectively studied five novice bronchoscopists entering a pulmonary and critical care medicine training program. They were taught to perform inspection flexible bronchoscopy using a VR bronchoscopy skill center; dexterity, speed, and accuracy were tested using the skill center and an inanimate airway model before and after 4 h of group instruction and 4 h of individual unsupervised practice. Results were compared to those of a control group of four skilled physicians who had performed at least 200 bronchoscopies during 2 years of training. Student's t tests were used to compare mean scores of study and control groups for the inanimate model and VR bronchoscopy simulator. Before-training and after-training test scores were compared using paired t tests. For comparisons between after-training novice and skilled physician scores, unpaired two-sample t tests were used.

Results

Novices significantly improved their dexterity and accuracy in both models. They missed fewer segments after training than before training, and had fewer contacts with the bronchial wall. There was no statistically significant improvement in speed or total time spent not visualizing airway anatomy. After training, novice performance equaled or surpassed that of the skilled physicians. Novices performed more thorough examinations and missed significantly fewer segments in both the inanimate and virtual simulation models.

Conclusion

A short, focused course of instruction and unsupervised practice using a virtual bronchoscopy simulator enabled novice trainees to attain a level of manual and technical skill at performing diagnostic bronchoscopic inspection similar to those of colleagues with several years of experience. These skills were readily reproducible in a conventional inanimate airway-training model, suggesting they would also be translatable to direct patient care.

Section snippets

Subjects and Curriculum Design

An 8-h teaching curriculum was designed to familiarize five novice pulmonary and critical care medicine fellows during the first 3 months of their first year of training (primary study group comprised of subjects 1 to 5) with basic techniques of FFB. None were previously trained in this procedure.

The first 4 h of the curriculum included (1) a 1-h group session during which trainees observed an on-line video about FFB provided with a bronchoscopy simulator (PreOp Endoscopy Simulator; HT Medical

Results

All novice trainees completed their individual, unsupervised training curriculums using the simulator. Four study subjects trained for the full 240 min allowed, whereas one subject trained for 210 min. The average duration of each individual practice session was 78 min (range, 30 to 160 min). Prior to this study, novice trainees had had only minimal exposure to FFB, having each previously observed or participated in an average of 10 procedures during their medical training (range, 0 to 15

Discussion

FFB is a commonly performed endoscopic procedure used for diagnosis and treatment of a variety of airway and pulmonary disorders. More than 500,000 of these procedures are performed each year by pulmonologists, otolaryngologists, anesthesiologists, and thoracic surgeons.9 Presumed competence in FFB is traditionally achieved during postgraduate specialty training. For pulmonologists, this entails 2 to 3 years of fellowship training after internal medicine residency.10

During fellowship training,

Acknowledgment

The authors thank HT Medical Systems Inc, Gaithersburg, MD, for use of their equipment.

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