A Longitudinal Study of Multimodal Bronchoscopy Training in Uganda

Abstract

Background Flexible bronchoscopy is an essential tool in diagnosing and managing pulmonary diseases. However, there is limited capacity for bronchoscopy in low and middle income countries (LMICs). In 2019, a pilot program for flexible bronchoscopy training was launched for local physicians in Kampala, Uganda. We then conducted a follow up multimodal bronchoscopy course after 2 years. Objective The aim of this study is to assess a longitudinal multimodal bronchoscopy training in an LMIC setting. Methods A multimodal follow up curriculum was developed with pulmonologists from Uganda and the United States. The training was delivered to Ugandan providers who attended previous bronchoscopy training and new participants. The training included a prepared curriculum consisting of lectures, simulations, and deliberate practice-based proctoring. A 12-question multiple-choice exam was administered at the beginning and end of the course, assessing knowledge. Procedural competency was measured using a validated assessment tool called the BSTAT (Bronchoscopic Skills and Tasks Assessment Tool). Results were analyzed to evaluate the retention of knowledge among those who took part in previous training and the efficacy of the follow-up curriculum for participants without previous training. Results Among the participants who attended didactic training in 2022 (11), mean exam scores were improved after training, from 43.9 (standard deviation [SD], 11.3) to 59.8 (SD, 16.1) (mean difference [MD], +15.9; SD, 13.9; P = 0.008), but were lower compared with post didactic scores in 2019: 90.8 (SD, 6.1; MD, −31; P < 0.0001). Participants who completed BSTAT assessments (8) had mean scores similar in 2019 and 2022, at 72.1 and 75.2, respectively (MD, 3.1; P = 0.38). Conclusion This study provides an example of how a longitudinal multimodal bronchoscopy curriculum can improve competency and proficiency for local physicians in an LMIC.

Knowledge Shared Is Knowledge Squared: Use of Technology and Multimodal Curricula Globally

“…Also in this issue of ATS Scholar , Karmali and colleagues investigated the effect of a multimodal fiberoptic bronchoscopy training program in Uganda, an LMIC, on providers’ knowledge and clinical skills ( 2 ). The training incorporated didactics, simulations, and deliberate practice-based proctoring followed by a 12-question multiple-choice assessment (before and after training) and a measure of procedural competency using the validated Bronchoscopic Skills and Tasks Assessment Tool.…”