Using virtual-reality simulation to assess performance in endobronchial ultrasound

Area of Science:

• Medical Simulation
• Respiratory Medicine
• Surgical Training

Background:

• Competence in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is crucial for non-small cell lung carcinoma treatment.
• Objective assessment of physician performance is needed for EBUS training and certification.

Purpose of the Study:

• To design an evidence-based and credible EBUS certification using a virtual-reality (VR) EBUS simulator.
• To establish objective performance standards for EBUS-TBNA through simulation.

Main Methods:

• Twenty-two physicians were divided into experienced operators, novices, and simulator-trained novices.
• Standardized simulated EBUS-TBNA procedures were performed, and simulator metrics were analyzed for discriminatory ability and reliability.
• A contrasting-groups method was used to establish a pass/fail standard for the VR EBUS simulator test.

Main Results:

• Successfully sampled lymph nodes and procedure time were key metrics differentiating performance (p=0.047 and p=0.002).
• The quality score (QS) showed acceptable reliability (0.67), with experienced operators achieving a median QS of 0.24 versus 0.098 for novices (p=0.001).
• A pass/fail standard of 0.19 was established; simulator-trained novices did not meet this standard.

Conclusions:

• Virtual-reality simulators can provide an objective assessment of EBUS-TBNA skills.
• VR EBUS simulators offer a credible first step in physician credentialing before patient-based supervised practice.
• Standardized VR EBUS tests and credible standard setting are essential for effective simulator-based training and certification.