Using Virtual-Reality Simulation to Assess Performance in Endobronchial Ultrasound

Abstract

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.

The effect of dyad versus individual simulation‐based ultrasound training on skills transfer

“…The use of different methods for assessing pre‐, post‐ and transfer test performances may have resulted in bias as there is some evidence that live performances are rated more highly than video‐recorded performances 35. Hence, the extent of skills transfer to the clinical setting may have been overestimated for both groups of participants as a result of rater leniency.…”

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: Patient Satisfaction under Light Conscious Sedation

“…It could be argued that the learning curve for the development of skills in EBUS-TBNA may affect patient satisfaction, but the primary operators were fully trained prior to the initiation of the study, so this was not relevant. Any such effect is also likely to adversely affect patient satisfaction, but this topic requires independent study [17,18,19]. We did not specifically investigate the impact of performance status or semi-recumbent positioning on patient satisfaction.…”

Simulator training for endobronchial ultrasound: a randomised controlled trial

“…Thus, we propose that all three steps should end with a test of competence before proceeding to the next step. Tests with validity evidence have been published regarding theoretical knowledge [28], performance on EBUS-TBNA simulators [29,30] and performance on patients EBUS-STAT [21] and EBUSAT (current study).…”