Chest
Volume 148, Issue 2, August 2015, Pages 321-332
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Evidence-Based Medicine
Adult Bronchoscopy Training: Current State and Suggestions for the Future: CHEST Expert Panel Report

https://doi.org/10.1378/chest.14-0678Get rights and content

BACKGROUND

The determination of competency of trainees in programs performing bronchoscopy is quite variable. Some programs provide didactic lectures with hands-on supervision, other programs incorporate advanced simulation centers, whereas others have a checklist approach. Although no single method has been proven best, the variability alone suggests that outcomes are variable. Program directors and certifying bodies need guidance to create standards for training programs. Little well-developed literature on the topic exists.

METHODS

To provide credible and trustworthy guidance, rigorous methodology has been applied to create this bronchoscopy consensus training statement. All panelists were vetted and approved by the CHEST Guidelines Oversight Committee. Each topic group drafted questions in a PICO (population, intervention, comparator, outcome) format. MEDLINE data through PubMed and the Cochrane Library were systematically searched. Manual searches also supplemented the searches. All gathered references were screened for consideration based on inclusion criteria, and all statements were designated as an Ungraded Consensus-Based Statement.

RESULTS

We suggest that professional societies move from a volume-based certification system to skill acquisition and knowledge-based competency assessment for trainees. Bronchoscopy training programs should incorporate multiple tools, including simulation. We suggest that ongoing quality and process improvement systems be introduced and that certifying agencies move from a volume-based certification system to skill acquisition and knowledge-based competency assessment for trainees. We also suggest that assessment of skill maintenance and improvement in practice be evaluated regularly with ongoing quality and process improvement systems after initial skill acquisition.

CONCLUSIONS

The current methods used for bronchoscopy competency in training programs are variable. We suggest that professional societies and certifying agencies move from a volume-based certification system to a standardized skill acquisition and knowledge-based competency assessment for pulmonary and thoracic surgery trainees.

Section snippets

Summary of Suggestions

  • 1

    We suggest that professional societies and certifying agencies move from a volume-based certification system to skill acquisition and knowledgebased competency assessment for pulmonary trainees (Ungraded Consensus-Based Statement).

  • 2

    We suggest that assessment of skill maintenance and improvement in practice be evaluated regularly in similar fashion as recurrent cognitive examinations (Ungraded Consensus-Based Statement).

  • 3

    We suggest that ongoing quality and process improvement systems after initial

Summary of Evidence

Currently, the determination of competency of trainees in pulmonary and critical care medicine in performing bronchoscopic procedures is entrusted to the fellowship program director by the American College of Graduate Medical Education (ACGME).6 The determination varies from program to program. Some programs provide fellows with several didactic lectures prior to their performing procedures with hands-on supervision; other programs incorporate advanced simulation centers, whereas others have

Summary of Evidence

An appropriate training program should include some didactic teaching in the form of lectures and be complemented with appropriate books.13, 14 Web-based learning using a digital resource such as videos of clinical examples of procedures enhances training.15 Training on inanimate models as part of a multimodality training program helps in the acquisition of specific skills.13

Several articles have suggested that the use of simulators for bronchoscopy and EBUS enhances and speeds up the learning

Summary of Evidence

Although bronchoscopy is a procedure that helps to define the pulmonologist, thoracic surgery training programs require residents to adequately perform a myriad of procedures, some of which are technically much more complicated than bronchoscopy. The available literature in the surgical field includes a limited number of studies, mostly dealing with junior-level general surgery residents (interns); ear, nose, and throat residents; and anesthesia residents.

The American Board of Thoracic Surgery

Summary of Evidence

Simulation technology in bronchoscopy is available in two forms: low-fidelity inanimate mechanical airway models and high-fidelity computer-based electronic simulation.26 Low-fidelity simulation models consist of molded tracheobronchial trees that offer realistic tubular-shaped airway-like structures with accurate anatomy to the first subsegmental bronchial level.27, 28 They assist novice learners in memorizing airway anatomy, building muscle memory, and enhancing hand-eye coordination. Their

Conclusions

In this in-depth review of the state of the art of teaching bronchoscopy in pulmonary medicine, the findings were not surprising. Few specific guidelines that govern training are available. They are quite divergent when covering the same procedure, depending on which specialty issues them and in what country the healthcare provider practices. Little guidance is given on modern teaching tools that should be used, and many documents still suggest volume-based criteria for assessing competency.

Acknowledgments

Author contributions: A. E. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. A. E., M. M. W., C. A. R., J. D. B., D. J. A.-H., P. L. S., F. J. F. H., A. d. H. P., J. O., L. Y., and G. A. S. participated in the literature review, condensing of the information, and drafting of the final suggestions. Specific assignments were as follows: The Current State of Competency Assessment in Training Bronchoscopy,

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    originally published Online First February 12, 2015.

    FUNDING/SUPPORT: This consensus statement was supported solely by internal funds from CHEST.

    DISCLAIMER: CHEST Expert Panel Reports are intended for general information only, are not medical advice, and do not replace professional medical care and physician advice, which always should be sought for any medical condition. The complete disclaimer for this guideline can be accessed at http://www.chestnet.org/Guidelines-and-Resources/Guidelines-and-Consensus-Statements/CHEST-Guidelines.

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