PURPOSE: To validate a transbronchial needle aspiration (TBNA) module of the bronchoscopy simulator for skill acquisition and assessment.
METHODS: Observational cross- sectional study in a tertiary care teaching hospital. Operators were classified as novice, intermediates and experts based on number of conventional TBNA previously performed (< 5, 5-50 or >50). In phase I (skill assessment) each participant received a 10 minute session of demonstration of the simulator (Endoscopy Accutouch System - CAE, Montreal, Quebec, Canada), by a dedicated preceptor followed by a test case at which performance measures (total procedure time, rate of successful sampling, scope trauma, and sample contamination) were recorded while the participant performed three TBNA in the subcarnial station. In phase II (skill acquisition) novice and intermediate participants were allowed to practice with the simulator to complete 4 simulated cases (each performed twice). Upon completion of their training, they were tested using the phase I protocol.
RESULTS: Seventeen consecutive participants were included in the study (8 novices, 2 intermediates, 7 experts). In phase I, experts performed better than intermediates and/or novices in terms of total procedure time (3.3 vs 4.2 and 9.6 minutes, respectively), rate of successful sampling (100% vs 50% and 37%, respectively), rate of scope trauma (0% vs 0% and 75%, respectively) and rate of sample contamination (0% vs 50% and 65%, respectively). After training with the simulator machine, novice performance in phase II improved in all of the above measures (total procedure time “ 9.6 to 5.7 minutes”, rate of successful sampling “37% to 100%”, scope trauma “75% to 14%”, and sample contamination “62% to 29%”).
CONCLUSION: The TBNA module of the bronchoscopy simulator reliably discriminates expert, intermediate and novice operators. Brief training intervention with this module helps to improve TBNA bronchoscopic skills and knowledge in the novice bronchoscopist.
CLINICAL IMPLICATIONS: Bronchoscopy simulators might have a role in the pulmonary fellowship programs to allow training and assessment of pulmonary fellows in a safe and controlled environment.
DISCLOSURE: Saleh Alazemi, No Financial Disclosure Information; No Product/Research Disclosure Information