Simulator training for endobronchial ultrasound: a randomised controlled trial

Area of Science:

• Pulmonology
• Medical Education
• Medical Simulation

Background:

• Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) requires extensive training due to its operator-dependent nature and steep learning curve.
• Simulation-based training offers a potential solution to accelerate skill acquisition and ensure proficiency.
• A validated assessment tool is crucial for certifying competency before independent EBUS-TBNA performance.

Purpose of the Study:

• To evaluate the effectiveness of virtual-reality (VR) simulator training compared to traditional apprenticeship for EBUS-TBNA.
• To assess the validity and reliability of a newly developed Endobronchial Ultrasound Assessment Tool (EBUSAT) for EBUS-TBNA competence.

Main Methods:

• 16 novice respiratory physicians were randomized to VR simulator training or traditional patient-based apprenticeship.
• All participants performed three EBUS-TBNA procedures on patients, recorded for assessment.
• Procedures were evaluated by three independent assessors using the EBUSAT, assessing internal consistency, generalizability, and discriminatory ability.

Main Results:

• The EBUSAT demonstrated high internal consistency (Cronbach's α=0.95) and good generalizability (0.86).
• Simulator-trained novices achieved significantly higher EBUSAT scores (24.2±7.9) than apprenticeship-trained novices (20.2±9.4; p=0.006).
• A pass/fail threshold (28.9 points) revealed higher failure rates for apprenticeship-trained novices (83%) versus simulator-trained novices (67%; p<0.001).

Conclusions:

• The EBUSAT provides a reliable and valid method for assessing EBUS-TBNA competence and can aid in certification.
• Virtual-reality simulator training is more effective than traditional apprenticeship in improving EBUS-TBNA skills for novices.
• VR simulation represents a promising approach to expedite the learning curve for EBUS-TBNA procedures.