Training on a new, portable, simple simulator transfers to performance of complex bronchoscopy procedures

Krogh, Charlotte Loumann; Konge, Lars; Bjurström, Johanna; Ringsted, Charlotte

doi:10.1111/j.1752-699x.2012.00311.x

Cited by 19 publications

(31 citation statements)

References 29 publications

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“…has a steep learning curve) there will be a considerable ceiling effect allowing trainees to pass the test after a brief training session. A study on flexible bronchoscopy simulation showed no differences between novices that had tried the simulator 5 times and experts [23], and in another study, 8 out of 10 medical students passed a simulator test after 1-3 h of training [24]. EBUS-TBNA is a difficult procedure to master and the fact that approximately 2 h of training did not allow the trainees to reach expert performance indicates that the VR simulator mimics the difficulties of real-life patients, and that the QS is an appropriate measure of competence.…”

Section: Discussionmentioning

confidence: 99%

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: 99%

Using Virtual-Reality Simulation to Assess Performance in Endobronchial Ultrasound

et al. 2013

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“…Similarly, it does not make sense to know the anatomy if you are not able to take biopsies. Krogh et al [16] and Konge et al [17] used the same assessment method, which ensures a comprehensive rating not only because of the equal emphasis on both anatomy and biopsy taking, but also because of its ability to discriminate between varying degrees of experience.…”

Section: Discussionmentioning

confidence: 99%

“…Of all the publications on flexible bronchoscopy, only a few included biopsies as an essential part of the operator assessment [16][17][18] . Two studies used the BSTAT during which the operator might be asked to perform a biopsy as 1 of a few standard tasks [20,24] .…”

Section: Assessmentmentioning

confidence: 99%

“…Studies Developing and/or Exploring Simulation Equipment Thirteen studies either gathered validity evidence for a simulation-based test [14,18,26,30,31] , compared different simulators [21,23,28] or described the effectiveness of alternative simulators, e.g., a human cadaver, a portable simulator or low-cost models [11,12,16,22,25] . When gathering validity evidence, the outcome measure that consistently differentiated novices from experts was procedure time.…”

Section: Flexible Bronchoscopymentioning

confidence: 99%

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

Naur¹,

Nilsson²,

Pietersen³

et al. 2017

Respiration

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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.

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“…Bronchoscopes and bronchoscopic procedures are changing as manufacturers move into GPS-like navigational devices, 3D stereoscopic instruments with enhanced optics, and multimodality devices that incorporate optical and acoustic and nano technology. Concurrently, educational opportunities are increasing because of new educational techniques, easily transportable and less expense computer-based simulators, and wider dissemination of affordable inanimate models [28,29].…”

Section: New Developments In Education Simulation and Computer Gamingmentioning

confidence: 99%

Simulation in bronchoscopy training: are we there yet?

Colt

2012

Curr Respir Care Rep

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The time has come for bronchoscopists around the world to recognize that simulation is the best alternative to learning on patients. Only in this way will patients no longer suffer the burden of procedure-related learning. Technical skills can be acquired, practiced, and improved by use of inanimate models and combinations of low and high-fidelity simulation, including increasingly portable computer-based trainers. Validated assessment tools and checklists can be used to measure a learner's progress towards competence, complementing assessments during direct observation and real patient experience. Simulation scenarios should include more than technical skill exercises, to encompass the full range of procedural practice. As simulation is increasingly incorporated into training programs, there is a need to use business ethics to enhance innovation and democratize new technology. Simulation in bronchoscopy training: we are not there yet, but we are certainly moving in the right direction.

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Training on a new, portable, simple simulator transfers to performance of complex bronchoscopy procedures

Abstract: The effect of a brief, self-directed training session using a portable, simple simulator was substantial and transferred to performance of more complex skills.

Cited by 19 publications

References 29 publications

Using Virtual-Reality Simulation to Assess Performance in Endobronchial Ultrasound

Using Virtual-Reality Simulation to Assess Performance in Endobronchial Ultrasound

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

Simulation in bronchoscopy training: are we there yet?

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