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Original Research: Pulmonary Procedures |

Learning Experience of Linear Endobronchial Ultrasound Among Pulmonary TraineesEndobronchial Ultrasound Learning Experience

Momen M. Wahidi, MD, MBA, FCCP; Cidney Hulett, MD, MPH; Nicholas Pastis, MD, FCCP; R. Wesley Shepherd, MD, FCCP; Scott L. Shofer, MD, PhD; Kamran Mahmood, MD, MPH; Hans Lee, MD, FCCP; Rajiv Malhotra, DO; Barry Moser, PhD; Gerard A. Silvestri, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine and Department of Medicine (Drs Wahidi, Shofer, Mahmood, and Moser), Duke University Medical Center, Durham, NC; the University of North Carolina (Dr Hulett), Chapel Hill, NC; the Medical University of South Carolina (Drs Pastis and Silvestri), Charleston, SC; and the Virginia Commonwealth University Medical Center (Drs Shepherd, Lee, and Malhotra), Richmond, VA.

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


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(3):574-578. doi:10.1378/chest.13-0701
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Background:  Linear endobronchial ultrasound (EBUS) allows real-time guidance of transbronchial needle aspiration of thoracic structures and has become an increasingly important diagnostic tool for chest physicians. Little has been published about the learning experience of operators with this technology. The purpose of this study was to define the learning experience of EBUS-guided transbronchial needle aspiration (EBUS-TBNA) among pulmonary trainees.

Methods:  This was a multicenter cohort study of fellows in pulmonary medicine over the first 2 years of their training. Prior to performing EBUS-TBNA, all participants had to complete 30 conventional bronchoscopies, an EBUS-specific didactic curriculum, and a simulation session with a plastic airway model. Each consecutive EBUS procedure was scored with a checklist that evaluated the ability to pass a bronchoscope through vocal cords, identify the appropriate node for sampling, acquire adequate ultrasound images, guide the bronchoscopy team through the technical steps of EBUS-TBNA, and obtain adequate tissue samples.

Results:  Thirteen pulmonary trainees from three training programs were enrolled in the study and were observed over a 2-year period. The majority of trainees were able to perform all essential steps of EBUS-TBNA and obtain adequate tissue after performing an average of 13 (95% CI, 7-16) procedures.

Conclusions:  Pulmonary trainees needed an average of 13 procedures to achieve first independent successful performance of EBUS-TBNA following a training protocol that included a didactic curriculum and simulation-based practice. Our findings could guide pulmonary fellowship directors in planning EBUS training and establishing a reasonable juncture to assess EBUS skills with validated assessment tools.

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