Centre for Clinical Education, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark.
Respiration. 2013;86(1):59-65. doi: 10.1159/000350428. Epub 2013 May 23.
For optimal treatment of patients with non-small cell lung carcinoma, it is essential to have physicians with competence in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). EBUS training and certification requirements are under discussion and the establishment of basic competence should be based on an objective assessment of performance.
The aims of this study were to design an evidence-based and credible EBUS certification based on a virtual-reality (VR) EBUS simulator test.
Twenty-two respiratory physicians were divided into 3 groups: experienced EBUS operators (group 1, n = 6), untrained novices (group 2, n = 8) and simulator-trained novices (group 3, n = 8). Each physician performed two standardized simulated EBUS-TBNA procedures. Simulator metrics with discriminatory ability were identified and reliability was explored. Finally, the contrasting-groups method was used to establish a pass/fail standard, and the consequences of this standard were explored.
Successfully sampled lymph nodes and procedure time were the only simulator metrics that showed statistically significant differences of p = 0.047 and p = 0.002, respectively. The resulting quality score (QS, i.e. sampled lymph nodes per minute) showed an acceptable reliability and a generalizability coefficient of 0.67. Reliability of 0.8 could be obtained by testing in 4 procedures. Median QS was 0.24 (range 0.21-0.26) and 0.098 (range 0.04-0.21) for groups 1 and 2, respectively (p = 0.001). The resulting pass/fail standard was 0.19. Group 3 had a median posttraining QS of 0.11 (range 0-0.17). None of them met the pass/fail standard.
With careful design of standardized tests, a credible standard setting and appropriate transfer studies, VR simulators could be an important first line in credentialing before proceeding to supervised performance on patients.
为了对非小细胞肺癌患者进行最佳治疗，医生必须具备支气管内超声引导经支气管针吸活检（EBUS-TBNA）方面的专业能力。目前正在讨论 EBUS 培训和认证要求，而基本能力的建立应基于对性能的客观评估。
本研究旨在设计一种基于虚拟现实（VR）EBUS 模拟器测试的基于循证和可信的 EBUS 认证。
将 22 名呼吸科医生分为 3 组：经验丰富的 EBUS 操作者（第 1 组，n=6）、未经培训的新手（第 2 组，n=8）和模拟器培训的新手（第 3 组，n=8）。每位医生进行了两次标准化的模拟 EBUS-TBNA 操作。确定具有区分能力的模拟器指标并探索其可靠性。最后，使用对比组方法建立通过/失败标准，并探讨该标准的后果。
成功采样的淋巴结和程序时间是唯一显示具有统计学意义差异的模拟器指标，p=0.047 和 p=0.002。由此产生的质量评分（QS，即每分钟采样的淋巴结）显示出可接受的可靠性和可推广性系数为 0.67。通过 4 次测试可获得 0.8 的可靠性。第 1 组和第 2 组的中位数 QS 分别为 0.24（范围 0.21-0.26）和 0.098（范围 0.04-0.21）（p=0.001）。由此产生的通过/失败标准为 0.19。第 3 组的中位数培训后 QS 为 0.11（范围 0-0.17）。他们都没有达到通过/失败标准。
通过精心设计的标准化测试、可信的标准设置和适当的转移研究，VR 模拟器可以成为在患者身上进行监督操作之前进行认证的重要第一步。
