TY - JOUR

T1 - Using structured progress to measure competence in flexible bronchoscopy

AU - Cold, Kristoffer Mazanti

AU - Svendsen, Morten Bo Søndergaard

AU - Bodtger, Uffe

AU - Nayahangan, Leizl Joy

AU - Clementsen, Paul Frost

AU - Konge, Lars

PY - 2020

Y1 - 2020

N2 - Background: Flexible bronchoscopy is a core invasive procedure in pulmonary medicine and training in the procedure is mandatory. Diagnostic completeness and procedure time have been identified as useful measures of competence. No outcome measures have been developed regarding navigational path in bronchoscopy to assess whether the bronchial segments have been identified in an arbitrary or structured order. We investigated whether a new outcome measure for structured progression could be used to assess competency in flexible bronchoscopy. Methods: The study was designed as a prospective comparative study. Twelve novices, eleven intermediates, and ten expert bronchoscopy operators completed three full bronchoscopies in a simulated setting on a phantom. The following outcome measures were collected through a checklist evaluation by a trained rater: Diagnostic Completeness as amount of visualized bronchial segments, Structured Progress between the bronchial segments in ascending order, and average intersegmental time (AIT). Results: The ability to follow a structured ascending path through the bronchial tree correlated with a higher amount of identified bronchial segments (Pearson's correlation, r=0.62, P<0.001) and a lower AIT (Pearson's correlation, r=−0.52, P<0.001). Conclusions: Operators should advance through the bronchial tree in a structured ascending order to ensure systematic progress with the highest level of diagnostic yield and the lowest procedure time. Structured progression is a useful measure to evaluate competency in flexible bronchoscopy.

AB - Background: Flexible bronchoscopy is a core invasive procedure in pulmonary medicine and training in the procedure is mandatory. Diagnostic completeness and procedure time have been identified as useful measures of competence. No outcome measures have been developed regarding navigational path in bronchoscopy to assess whether the bronchial segments have been identified in an arbitrary or structured order. We investigated whether a new outcome measure for structured progression could be used to assess competency in flexible bronchoscopy. Methods: The study was designed as a prospective comparative study. Twelve novices, eleven intermediates, and ten expert bronchoscopy operators completed three full bronchoscopies in a simulated setting on a phantom. The following outcome measures were collected through a checklist evaluation by a trained rater: Diagnostic Completeness as amount of visualized bronchial segments, Structured Progress between the bronchial segments in ascending order, and average intersegmental time (AIT). Results: The ability to follow a structured ascending path through the bronchial tree correlated with a higher amount of identified bronchial segments (Pearson's correlation, r=0.62, P<0.001) and a lower AIT (Pearson's correlation, r=−0.52, P<0.001). Conclusions: Operators should advance through the bronchial tree in a structured ascending order to ensure systematic progress with the highest level of diagnostic yield and the lowest procedure time. Structured progression is a useful measure to evaluate competency in flexible bronchoscopy.

KW - Assessment

KW - Education

KW - Flexible bronchoscopy

KW - Mastery learning

KW - Simulation

U2 - 10.21037/jtd-20-2181

DO - 10.21037/jtd-20-2181

M3 - Journal article

C2 - 33282381

AN - SCOPUS:85097163105

VL - 12

SP - 6797

EP - 6805

JO - Journal of Thoracic Disease

JF - Journal of Thoracic Disease

SN - 2072-1439

IS - 11

ER -