PURPOSE: Bronchoscopy education is an integral component of the overall training experience in pulmonary fellowships. Assessment of bronchoscopic skills has not been standardized and currently relies solely on procedure logbooks and subjective letters of competency. The multi-state bronchoscopy education project is a format for competency-based measurements of bronchoscopic cognitive and technical skills acquisition. We report the initial data on first year fellow's comfort level for performing bronchoscopy.
METHODS: Null Hypothesis: Pulmonary fellows will not feel comfortable by the 50th bronchoscopy.25 first year pulmonary fellows from 7 academic institutions participated in the multi-state bronchoscopy education project and answered an 8 question self assessment tool at their 5th, 10th, 15th, 20th, 30th, 50th, 75th and 100th procedure. This measured the trainee's comfort level in performing bronchoscopy and related procedures, knowledge of airway anatomy, and ability to manipulate the bronchoscope. The trainees rated their level of comfort on a scale of 1 through 5, with a score of 1-2 considered not comfortable, 3-4 comfortable, and 5 very comfortable.
RESULTS: The average self assessment score for the fellow's (N=9) bronchoscopic skills from 2 of the sites are as follows: 5th 1.8, 10th 2.29, 15th 2.8, 20th 2.9, 30th 3.2, 50th 3.4, 75th 3.6, 100th 4.1.
CONCLUSION: In contrast to our initial belief that 50 bronchoscopies are necessary to achieve an adequate comfort level, the bronchoscopy skills self assessment tool reveals that the transition from uncomfortable to comfortable occurs between the 20th and 30th procedure. Comfort levels continued to improve with increasing experience, but a level of very comfortable was only achieved in 1 out of 6 first year fellows who reached the 100th bronchoscopy mark.
CLINICAL IMPLICATIONS: The bronchoscopy self assessment tool should be utilized in concert with objective measurements of bronchoscopic cognitive and technical skills and may be useful in bronchoscopy education by identifying areas of needed improvement, promoting confidence and determining the number of procedures required to be considered competent. Further studies and tests for validation are needed and are forthcoming.
DISCLOSURE: Mark Bowling, No Product/Research Disclosure Information; Other We recieved funding from the Interventional Chest/Diagnostic Procedures NetWork project for The Multi State Bronchoscopy Project.