PURPOSE: Bronchoscopy is an important component of a pulmonologist's skills. The safe and effective use of a bronchoscope is a major goal of the training of pulmonary fellows. However, bronchoscopy skills acquisition has not been standardized and relies on procedure logbooks as the main confirmation of competency. We report the initial data on practical bronchoscopic skills acquisition in a cohort of first year pulmonary fellows using a uniformly applied skill assessment tool.
METHODS: Fellows were enrolled in the study during their fist week of fellowship while attending a bronchoscopy course at Duke University. Their bronchoscopy skills were assessed during the course as a baseline measure (bronchoscopy #1) then at pre-specified procedure milestones throughout their first year of fellowship training: the 5th, 10th, 15th, 20th, 30th, 50th, 75th and 100th bronchoscopies. A validated assessment tool was used to score the fellow's ability to recognize airway anatomy and pathology, manipulate the bronchoscope, and perform bronchoscopic techniques. Scoring was performed at each site by 2 staff that had been trained in the use of the assessment tool.
RESULTS: Fifteen fellows were enrolled; all 9 data points were collected for 80% of them to date. The assessment tool scores varied by timeline and frequency as each institution's bronchoscopy exposure varied. Skill acquisition demonstrated a positive linear relationship with the number of bronchoscopy performed (graph-1).
CONCLUSION: Our results present a unique look at bronchoscopy skill acquisition in naïve operators. As expected, acquisition of bronchoscopy practical skills increased proportional to the number of procedures performed. This held true across the participating centers despite significant heterogeneity in bronchoscopy curriculum and teaching. More importantly, it appears that the currently recommended number of 50 bronchoscopies, as a requirement for bronchoscopy certification in fellowship training, may fall short of the rising learning curve demonstrated in our study.
CLINICAL IMPLICATIONS: The understanding of the learning curve of starting pulmonary fellows in acquiring bronchoscopy skills will enhance the training experience of future fellows and facilitate the creation of bronchoscopy curriculum and standards.
DISCLOSURE: Momen Wahidi, No Financial Disclosure Information; No Product/Research Disclosure Information