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Original Research: SIMULATION-BASED TRAINING |

A Prospective Multicenter Study of Competency Metrics and Educational Interventions in the Learning of Bronchoscopy Among New Pulmonary Fellows

Momen M. Wahidi, MD, MBA, FCCP; Gerard A. Silvestri, MD, MS, FCCP; Raymond D. Coakley, MD; J. Scott Ferguson, MD, FCCP; R. Wesley Shepherd, MD; Leonard Moses, MD, FCCP; John Conforti, DO; Loretta G. Que, MD; Kevin J. Anstrom, PhD; Franklin McGuire, MD, FCCP; Henri Colt, MD, FCCP; Gordon H. Downie, MD, PhD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (Drs Wahidi and Que) and Department of Biostatistics and Bioinformatics (Dr Anstrom), Duke University Medical Center, Durham, NC; the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (Dr Silvestri), Medical University of South Carolina, Charleston, SC; the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (Dr Coakley), University of North Carolina, Chapel Hill, NC; the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (Dr Ferguson), University of Iowa, Iowa City, IA; the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (Drs Shepherd and Moses), Virginia Commonwealth University Medical Center, Richmond, VA; the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (Dr Conforti), Wake Forest University School of Medicine, Winston-Salem, NC; the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (Dr McGuire), University of South Carolina, Columbia, SC; the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (Dr Colt), University of California at Irvin, Orange, CA; and the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (Dr Downie), Brody School of Medicine at East Carolina University, Greenville, NC.

Correspondence to: Momen M. Wahidi, MD, MBA, FCCP, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Box 3683, Durham, NC 27710; e-mail: momen.wahidi@duke.edu


Funding/Support: The study was funded by the American College of Chest Physicians (ACCP). This study originated as a project of the Interventional Chest/Diagnostic Procedures Network of the ACCP.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).

For editorial comment see page 1009


© 2010 American College of Chest Physicians


Chest. 2010;137(5):1040-1049. doi:10.1378/chest.09-1234
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Background:  Learning medical procedures relies predominantly on the apprenticeship model, and competency is established based on the number of performed procedures. Our study aimed to establish bronchoscopy competency metrics based on performance and enhanced learning with educational interventions.

Methods:  We conducted a prospective study of the acquisition of bronchoscopy skills and cognitive knowledge in two successive cohorts of new pulmonary fellows between July 5, 2006, and June 30, 2008. At prespecified milestones, validated tools were used for testing: the Bronchoscopy Skills and Tasks Assessment Tool (BSTAT), an objective evaluation of bronchoscopy skills with scores ranging from 0 to 24, and written multiple-choice questions examinations. The first cohort received training in bronchoscopy as per the standards set by each institution, whereas the second cohort received educational interventions, including training in simulation bronchoscopy and an online bronchoscopy curriculum.

Results:  There was significant variation among study participants in bronchoscopy skills at their 50th bronchoscopy, the minimum number previously set to achieve competency in bronchoscopy. An educational intervention of incorporating simulation bronchoscopy enhanced the speed of acquisition of bronchoscopy skills, as shown by the statistically significant improvement in mean BSTAT scores for seven of the eight milestone bronchoscopies (P < .05). The online curriculum did not improve the performance on the written tests; however, compliance of the learners with the curriculum was low.

Conclusions:  Performance-based competency metrics can be used to evaluate bronchoscopy skills. Educational interventions, such as simulation-based training, accelerated the acquisition of bronchoscopy skills among first-year pulmonary fellows as assessed by a validated objective assessment tool.

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