From prototype to national standard: a governance framework for scaling simulation-based bronchoscopy training

Simulation-based education can improve procedural training, but national adoption depends on governance, scalability, quality assurance, and alignment with postgraduate certification requirements. This Advancing Simulation Practice report describes how bronchoscopy simulation developed from a pilot educational initiative into a mandatory national component of postgraduate pulmonary medicine training.

We present a practice-based implementation account of a national reform in procedural training, using bronchoscopy as the index procedure. Rather than testing an effectiveness hypothesis, we examine programme design, governance, scale-up, instructor development, quality assurance, and regulatory embedding. The Consolidated Framework for Implementation Research and the RE-AIM framework were used to structure reflection on implementation determinants and programme outcomes, rather than as prospectively applied measurement instruments. The national simulation programme trained 402 physicians across procedural specialties, supported by 85 nationally certified instructors, and delivered 184 structured training cycles comprising 5,999 instructional hours. The bronchoscopy component enrolled 186 pulmonary specialty trainees, of whom 185 completed the course; 46 instructors were certified to deliver bronchoscopy training. Post-course evaluations showed high perceived relevance and increased self-reported confidence, which are interpreted as acceptability and early implementation indicators rather than evidence of clinical competence. Following national evaluation, bronchoscopy simulation was incorporated in 2024 as a mandatory component of postgraduate specialisation training in pulmonary diseases. Scale-up was supported by national-level European Union structural funding for health workforce development and simulation infrastructure, including POWER project POWR.04.03.00-00-0291/16, in which bronchoscopy formed one component of broader endoscopic simulation capacity.

The main contribution of this programme was the governance pathway that enabled simulation to progress from local innovation to national training policy. Sustainable implementation depended on staged scale-up, explicit curriculum design, instructor certification, common standard operating procedures, external quality assurance, distributed simulation-centre capacity, and alignment with regulatory postgraduate training requirements. Future evaluation should examine clinical transfer, workplace performance, and patient-safety outcomes.