Lee Hans J, Lerner Andrew D, Coleman Briana, Semaan Roy, Mallow Christopher, Arias Sixto, Salwen Ben, Feller-Kopman David, Yarmus Lonny
Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
J Bronchology Interv Pulmonol. 2019 Jan;26(1):55-61. doi: 10.1097/LBR.0000000000000520.
Prior studies in pulmonology have examined the validity of procedural training tools, however, translation of simulation skill acquisition into real world competency remains understudied. We examine an assessment process with a simulation training course for electromagnetic navigational (EMN) bronchoscopy and percutaneous transthoracic needle aspiration (PTTNA).
A cohort study was conducted by subjects using EMN bronchoscopy and PTTNA. A procedural assessment tool was developed to measure basic competency for EMN bronchoscopy and PTTNA at 3 different time points: first simulation case, final simulation case upon reaching a competent score, and at their first live case. The assessment tool was divided into 4 domains (total score, 4 to 16; competency ≥12) with each domain requiring a passing score (1 to 4; competency ≥3.0). Complication and procedural time were collected during their first live case.
Twenty-two serial procedures (12 EMN bronchoscopies, 10 EMN PTTNA) were observed by 14 subjects. The mean first simulation score for EMN bronchoscopy (4.66±0.89) improved after cadaver simulation (12.67±0.89, median 3 simulations attempts). The subjects' mean score for their first live case was 13.0±0.85 (self-reported score 12.5±1.07). For EMN PTTNA, the mean first simulation score (4.3±2.40) improved after cadaver simulation (12.6±1.51, median 3 simulation attempts). The subjects' mean score for their first live PTTNA case was 12.5±2.87 (self-reported score 12.1±1.05). There was only 1 minor complication.
Learning EMN bronchoscopy/PTTNA is feasible using a structured simulation course with an assessment tool.
先前在肺病学领域的研究已经检验了程序训练工具的有效性,然而,将模拟技能的习得转化为实际操作能力仍未得到充分研究。我们研究了一个针对电磁导航(EMN)支气管镜检查和经皮经胸针吸活检术(PTTNA)的模拟培训课程的评估过程。
对使用EMN支气管镜检查和PTTNA的受试者进行了一项队列研究。开发了一种程序评估工具,以在3个不同时间点测量EMN支气管镜检查和PTTNA的基本能力:第一个模拟病例、达到合格分数后的最后一个模拟病例以及他们的第一个实际病例。评估工具分为4个领域(总分4至16分;能力≥12分),每个领域都需要达到及格分数(1至4分;能力≥3.0分)。在他们的第一个实际病例中收集并发症和操作时间。
14名受试者观察了22个连续程序(12例EMN支气管镜检查,10例EMN PTTNA)。EMN支气管镜检查的首次模拟平均得分(4.66±0.89)在尸体模拟后有所提高(12.67±0.89,中位数3次模拟尝试)。受试者第一个实际病例的平均得分是13.0±0.85(自我报告得分12.5±1.07)。对于EMN PTTNA,首次模拟平均得分(4.3±2.40)在尸体模拟后有所提高(12.6±1.51,中位数3次模拟尝试)。受试者第一个实际PTTNA病例的平均得分是12.5±2.87(自我报告得分12.1±1.05)。仅出现1例轻微并发症。
使用带有评估工具的结构化模拟课程学习EMN支气管镜检查/PTTNA是可行的。