Chest
Evidence-Based MedicineAdult Bronchoscopy Training: Current State and Suggestions for the Future: CHEST Expert Panel Report
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.