PURPOSE: Linear endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) is a revolutionary pulmonary procedure that can be challenging to learn, and for which little is known about its learning curve. This study describes the EBUS-TBNA learning curves of Interventional Pulmonary (IP) fellows over the course of their fellowship-training year.
METHODS: A prospective study assessing the EBUS-TBNA technical skills of two IP fellows over the course of 200 clinical cases during each fellow’s training. EBUS-TBNA technical skill was assessed throughout their yearlong fellowship training by performing 2 EBUS-TBNA test cases on a validated EBUS-TBNA computer simulator. Simulator testing was performed approximately after every 25 clinical EBUS-TBNA cases performed by the fellow. Other than for the test cases, the IP fellows did not use the simulator during their IP fellowship.
RESULTS: Early plateaus were seen for both IP fellows for percentage of successful biopsies (75 cases for both fellows) and time to intubation (50 cases for fellow 1 and 25 cases for fellow 2). Improvements were seen for total procedure time until a plateau was seen after 150 cases for fellow 1 and after 125 cases for fellow 2. Percentage of lymph nodes correctly identified on ultrasound exam did not show a clear plateau, but reached > 90% after 190 cases for fellow 1 and 150 cases for fellow 2. The EBUS-TBNA efficiency performance score (percentage of lymph nodes correctly identified on ultrasound exam/total procedure time) continued to improve up to 200 clinical cases in both fellows but both achieved an EBUS efficiency score in the range of expert EBUS bronchoscopists (as demonstrated in previous studies) after 143 (fellow 1) and 75 (fellow 2) clinical cases.
CONCLUSIONS: EBUS-TBNA technical skill as assessed using an EBUS-TBNA simulator improves progressively as clinical EBUS-TBNA experience is gained. The two IP fellows achieved expert skill level in EBUS efficiency performance score by 143 and 75 clinical cases respectively.
CLINICAL IMPLICATIONS: EBUS-TBNA simulators can be used to monitor progress of technical skill during EBUS-TBNA training. Reaching expert level skills in EBUS may require performance of a substantial number of clinical cases.
DISCLOSURE: The following authors have nothing to disclose: David Stather, Paul MacEachern, Alex Chee, Elaine Dumoulin, Alain Tremblay
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