Training for Linear Endobronchial Ultrasound Among US Pulmonary/Critical Care Fellowships

Tanner, Nichole T.; Pastis, Nicholas J.; Silvestri, Gerard A.

doi:10.1378/chest.12-0212

Cited by 31 publications

(29 citation statements)

References 34 publications

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“…A recent survey among pulmonary fellowship directors in the USA found that only 30% of programs had a formal protocol in place to evaluate EBUS competency [14]. We argue that high-fidelity VR simulators like the EBUS simulator used in this study could be used for initial training and assessment of basic competence before proceeding to supervised practice on patients.…”

Section: Discussionmentioning

confidence: 96%

Using Virtual-Reality Simulation to Assess Performance in Endobronchial Ultrasound

et al. 2013

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Background: For optimal treatment of patients with non-small cell lung carcinoma, it is essential to have physicians with competence in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). EBUS training and certification requirements are under discussion and the establishment of basic competence should be based on an objective assessment of performance. Objectives: The aims of this study were to design an evidence-based and credible EBUS certification based on a virtual-reality (VR) EBUS simulator test. Methods: Twenty-two respiratory physicians were divided into 3 groups: experienced EBUS operators (group 1, n = 6), untrained novices (group 2, n = 8) and simulator-trained novices (group 3, n = 8). Each physician performed two standardized simulated EBUS-TBNA procedures. Simulator metrics with discriminatory ability were identified and reliability was explored. Finally, the contrasting-groups method was used to establish a pass/fail standard, and the consequences of this standard were explored. Results: Successfully sampled lymph nodes and procedure time were the only simulator metrics that showed statistically significant differences of p = 0.047 and p = 0.002, respectively. The resulting quality score (QS, i.e. sampled lymph nodes per minute) showed an acceptable reliability and a generalizability coefficient of 0.67. Reliability of 0.8 could be obtained by testing in 4 procedures. Median QS was 0.24 (range 0.21-0.26) and 0.098 (range 0.04-0.21) for groups 1 and 2, respectively (p = 0.001). The resulting pass/fail standard was 0.19. Group 3 had a median posttraining QS of 0.11 (range 0-0.17). None of them met the pass/fail standard. Conclusions: With careful design of standardized tests, a credible standard setting and appropriate transfer studies, VR simulators could be an important first line in credentialing before proceeding to supervised performance on patients.

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Section: Discussionmentioning

confidence: 96%

Using Virtual-Reality Simulation to Assess Performance in Endobronchial Ultrasound

et al. 2013

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“…Endobronchial ultrasonography (EBUS) and transoesophageal ultrasonography (EUS) have replaced surgical mediastinoscopy as the first choice to obtain tissue confirmation [1,2]. Consequently, the availability of EBUS equipment has increased exponentially [3]. However, this rapid dissemination has occurred without a consensus on how operators should be trained and how procedural competency should be assessed.…”

Section: Introductionmentioning

confidence: 99%

Simulator training for endobronchial ultrasound: a randomised controlled trial

et al. 2015

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Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is very operator dependent and has a long learning curve. Simulation-based training might shorten the learning curve, and an assessment tool with solid validity evidence could ensure basic competency before unsupervised performance.A total of 16 respiratory physicians, without EBUS experience, were randomised to either virtual-reality simulator training or traditional apprenticeship training on patients, and then each physician performed EBUS-TBNA procedures on three patients. Three blinded, independent assessor assessed the video recordings of the procedures using a newly developed EBUS assessment tool (EBUSAT).The internal consistency was high (Cronbach's α=0.95); the generalisability coefficient was good (0.86), and the tool had discriminatory ability ( p<0.001). Procedures performed by simulator-trained novices were rated higher than procedures performed by apprenticeship-trained novices: mean±SD are 24.2±7.9 points and 20.2±9.4 points, respectively; p=0.006. A pass/fail standard of 28.9 points was established using the contrasting groups method, resulting in 16 (67%) and 20 (83%) procedures performed by simulatortrained novices and apprenticeship-trained novices failing the test, respectively; p<0.001.The endobronchial ultrasound assessment tool could be used to provide reliable and valid assessment of competence in EBUS-TBNA, and act as an aid in certification. Virtual-reality simulator training was shown to be more effective than traditional apprenticeship training. @ERSpublications Virtual-reality simulation-based training shortens the learning curve for endobronchial ultrasound (EBUS)

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“…5,22 Although there are fewer data on TBNA and EBUS underuse, surveys of pulmonologists and pulmonary fellows have shown that bronchoscopy training varies signifi cantly, and presumably, practice patterns vary accordingly. 9,10,[23][24][25] This is in the context of randomized strategy of sampling peripheral lung masses fi rst. 17 The present study adds to the existing body of knowledge in this area.…”

Section: Discussionmentioning

confidence: 99%

“…EBUS-TBNA or mediastinoscopy fi rst with thoracotomy to follow if the nodes are normal are both controlled studies demonstrating that EBUS-TBNA is at least as good as mediastinoscopy and, in some cases, is more effective and less costly than mediastinoscopy. [26][27][28] More recent studies suggested that EBUS-TBNA is gaining traction, 25 but how far it has penetrated into the community is not clear. The present study builds on the existing literature in this area by more directly measuring the quality gap.…”

Section: Discussionmentioning

confidence: 99%

Quality Gaps and Comparative Effectiveness in Lung Cancer Staging and Diagnosis

Ost

Niu

Elting

et al. 2014

Chest

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Background: Guidelines recommend mediastinal lymph node sampling as the fi rst invasive test in patients with suspected lung cancer with mediastinal lymphadenopathy without distant metastases, but there are no comparative effectiveness studies on how test sequencing affects outcomes. The objective was to compare practice patterns and outcomes of diagnostic strategies in patients with lung cancer. Methods: The study included a retrospective cohort of 15,316 patients with lung cancer with regional spread without distant metastases in the Surveillance, Epidemiology, and End Results or Texas Cancer Registry Medicare-linked databases. If the fi rst invasive test involved mediastinal sampling, patients were classifi ed as receiving guideline-consistent care; otherwise, they were classifi ed as receiving guideline-inconsistent care. We used propensity matching to compare the number of tests performed and multivariate logistic regression to compare the frequency of complications. Results: Twenty-one percent of patients had guideline-consistent diagnostic evaluations. Among patients with non-small cell lung cancer, 44% never had mediastinal sampling. Patients who had guideline-consistent care required fewer tests than those with guideline-inconsistent care ( P , .0001), including thoracotomies (49% vs 80%, P , .001) and CT image-guided biopsies (9% vs 63%, P , .001), although they had more transbronchial needle aspirations (37% vs 4%, P , .001). The consequence was that patients with guideline-consistent care had fewer pneumothoraxes (4.8% vs 25.6%, P , .0001), chest tubes (0.7% vs 4.9%, P , .001), hemorrhages (5.4% vs 10.6%, P , .001), and respiratory failure events (5.3% vs 10.5%, P , .001). Conclusions: Guideline-consistent care with mediastinal sampling fi rst resulted in fewer tests and complications. We found three quality gaps: failure to sample the mediastinum fi rst, failure to sample the mediastinum at all in patients with non-small cell lung cancer, and overuse of thoracotomy. CHEST 2014; 145(2):331-345Abbreviations: EBUS 5 endobronchial ultrasound; NSCLC 5 non-small cell lung cancer; SEER 5 Surveillance, Epidemiology, and End Results; TBNA 5 transbronchial needle aspiration; TCR 5 Texas Cancer Registry

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Training for Linear Endobronchial Ultrasound Among US Pulmonary/Critical Care Fellowships

Cited by 31 publications

References 34 publications

Using Virtual-Reality Simulation to Assess Performance in Endobronchial Ultrasound

Using Virtual-Reality Simulation to Assess Performance in Endobronchial Ultrasound

Simulator training for endobronchial ultrasound: a randomised controlled trial

Quality Gaps and Comparative Effectiveness in Lung Cancer Staging and Diagnosis

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