Training for endobronchial ultrasound: methods for proper training in new bronchoscopic techniques

The field of pulmonary medicine has experienced a rapid growth in innovative new technologies aimed at both diagnosis and treatment of airway, mediastinal and parenchymal disorders. Endobronchial ultrasound (EBUS) has emerged as an extremely useful tool in real-time guidance of transbronchial needle aspiration (TBNA) of mediastinal and hilar structures. A growing body of evidence has demonstrated the efficacy of EBUS-TBNA in the diagnosis and staging of lung cancer, as well as the diagnosis of benign causes of mediastinal and hilar lymphadenopathy. This has increased the demand for EBUS among general pulmonologists and thoracic surgeons and is presenting a challenge in establishing teaching venues and training guidelines to gain competence in EBUS.

The effectiveness of innovative teaching methods has been demonstrated with basic bronchoscopy skills. Several studies have successfully validated the efficacy of virtual reality simulators as a tool in the training of novice bronchoscopists, including a prospective, multicenter study that found a clear improvement in bronchoscopic skills with early use of virtual reality simulators. However, there is a paucity of literature that has specifically addressed the skills necessary for training in EBUS bronchoscopy.

Evidence-based protocols for teaching EBUS-guided TBNA and other advanced bronchoscopic procedures are necessary as these technologies continue to expand into general pulmonary practice. Ongoing research in bronchoscopy education promises to guide proper and effective training of clinicians to achieve learners' satisfaction and optimal patient outcomes.