PURPOSE: Flexible bronchoscopy is the most common diagnostic and therapeutic procedure performed by pulmonologists. There is currently no standardized test that objectively measures the technical skills needed to perform a safe, effective, and efficient bronchoscopy. In the age of patient safety and standardized education, this is a deficiency. The authors have created two such instruments. The BSTAT (Bronchoscopy Skills and Tasks Assessment Tool) grades the performance of an operator performing a diagnostic bronchoscopy, with an associated extra task such as bronchoalveolar lavage or endobronchial brushing. The BSET (Bronchoscopy Stepwise Evaluation Tool) grades the operator as s/he performs a series of laddered bronchoscopy exercises, which have also been devised by the authors as part of a comprehensive bronchoscopy curriculum.
METHODS: 21 participants at three different levels of expertise –novice, trainee, and expert –performed a diagnostic bronchoscopy, along with the standard bronchoscopy curriculum exercises, using a virtual reality bronchoscopy simulator. Two testers, who were blinded to each other’s score sheet, scored them using the BSTAT and BSET. The tests were performed twice for each participant, with a minimum time interval between the two sessions. The results of the tests were analyzed by using intraclass correlations to examine agreement within and between raters and by level of expertise.
RESULTS: Intraclass correlations showed that agreement was high, both within and between raters for both tests. The level of agreement between tests, and differences by level of expertise, all reached statistical significance.
CONCLUSION: The high level of inter-rater and inter-test agreement shows that these instruments have a high degree of precision and accuracy. The correlation with level of training and expected expertise attests to the validity and reliability of the BSTAT and BSET instruments.
CLINICAL IMPLICATIONS: With the new emphasis on reduction of procedure-related morbidity and improvement of patient safety, and in line with standardization and certification of educational curricula, the use of validated methods in teaching and testing bronchoscopic skills is an important step in assuring patient safety and improving quality of care.
DISCLOSURE: Mohsen Davoudi, None.