Simulation-Based Training in Flexible Bronchoscopy and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA): A Systematic Review

Abstract

Background: The use of simulators in a training programme for technically challenging procedures has the advantages of lowering the risk of patient complications while helping the trainees with the initial part of their learning curve. Objectives: The aim of this study was to perform a systematic review of simulation-based training in flexible bronchoscopy and endobronchial ultrasound (EBUS). Methods: We identified 1,006 publications in the PubMed database and included publications on flexible bronchoscopy below the carina and EBUS involving hands-on simulation-based training. Publications were excluded if they were written in languages other than English, if paediatric airways were involved or if they were not journal articles. The screening process was performed by 2 individuals, and a third reviewer made the final decision in case of disagreement. Results: We included 30 publications. The studies included participants of varying experience and most commonly used a virtual reality simulator as a training modality. Assessment of the participants' skills was based on simulator metrics or on an assessment tool. Some studies included performance on patients for assessment of the operator after training on a simulator. Conclusions: Simulation-based training was demonstrated to be more efficient than the traditional apprenticeship model. Physical models and virtual reality simulators complement each other. Simulation-based education should be based on a mastery learning approach and structured as directed self-regulated learning in a distributed training programme.

Simulation-Based Mastery Learning of Flexible Bronchoscopy: Deciding Factors for Completion

“…A systematic review of flexible bronchoscopy concluded that simulation-based education in flexible bronchoscopy should be based on a mastery learning approach and structured as directed self-regulated learning in a distributed training program [31], the same way our course was structured. However, distributive practice in its form during the course does not seem to be effective with regards to ensuring that all trainees achieve the desired level of competence, as only 43% of the trainees completed the course.…”

Simulation in bronchoscopy: current and future perspectives

“…Our group conducted an extensive systematic review on simulation in airway endoscopy with a database search in July 2016. 9 For this review, we updated the search (July 2017) to include the latest research. Articles’ relevance for simulation training of bronchoscopy was assessed independently by two of the authors.…”

Interventional Pulmonology: The Role of Simulation Training and Competency-Based Evaluation

“…Physical models and virtual reality simulators complement each other. 21 Stather et al also demonstrated that the simulation-trained group acquired skills more rapidly. 22 However, increasing the widespread adoption of simulators has been limited due to the cost and availability.…”

“…Recent studies have shown that the use of simulators for EBUS training is superior to conventional apprenticeship models. 21 Standardized assessment of cognitive and technical skill is important in both simulation and clinical setting. EBUS STAT is a 10 point validated instrument which helps assess cognitive and technical skills.…”