Departments of Respiratory Medicine.
Department of Intensive Care Medicine, Alfred Hopsital, Prahran, Vic., Australia.
J Bronchology Interv Pulmonol. 2020 Oct;27(4):280-285. doi: 10.1097/LBR.0000000000000664.
Simulation is invaluable for bronchoscopy training. Studies report improved procedure time, dexterity/technique, and trainee satisfaction supported by low-fidelity and high-fidelity simulators in structured-training programs. We sought to determine (1) Learning-gain in bronchoscopic dexterity after a single 45-minute unstructured exposure using a low-fidelity simulator. (2) Whether acquired skills are maintained 8 weeks later, during which trainees receive no interim exposure to simulation or clinical bronchoscopy.
Using a low-fidelity model, medical students were assessed for bronchoscopicdexterity before and after an unstructured, self-directed 45-minute simulation. Bronchoscopic dexterity was assessed according to: (1) Ability to enter a target-bronchus within a specified time. (2) The modified Bronchoscopy Skills and Tasks Assessment Tool (mBSTAT). Scores were compared at baseline, postsimulation, and 8 weeks postsimulation. Individual domains of the mBSTAT were compared with identify specific skills demonstrating more significant deterioration.
Twenty-eight medical students completed the initial-simulation session. Fifteen returned at 8 weeks. Statistically significant improvement in bronchoscopic-skills was observed immediately following the simulation session (mBSTAT scores 3.7±1.2 pretest vs. 7.0±0.9 posttest, P<0.001). mBSTAT scores had deteriorated significantly at 8 weeks (5.7±1.8, P=0.03) but remained superior to baseline scores (P=0.002). Of the 4 domains assessed, only Precision did not demonstrate any change between post-test and review assessments (P=0.14). All other domains demonstrated trends towards significant deterioration between posttest and review.
A single 45-minute unstructured bronchoscopy simulation session resulted in significant improvement in bronchoscopic dexterity. Significant decay in bronchoscopic dexterity is observed, suggesting repeat simulation may be valuable following periods without bronchoscopy exposure.
模拟在支气管镜检查培训中具有不可估量的价值。研究报告称，在结构化培训计划中，使用低保真度和高保真度模拟器可以提高程序时间、灵巧性/技术以及学员满意度。我们旨在确定：(1) 使用低保真度模拟器进行单次 45 分钟非结构化暴露后，支气管镜检查灵巧性的学习收益。(2) 8 周后，学员在没有模拟或临床支气管镜检查的情况下，是否仍能保持已获得的技能。
使用低保真度模型，在非结构化、自我指导的 45 分钟模拟前后，评估医学生的支气管镜检查灵巧性。根据以下方面评估支气管镜检查灵巧性：(1) 在规定时间内进入目标支气管的能力。(2) 修改后的支气管镜技能和任务评估工具 (mBSTAT)。在基线、模拟后和模拟后 8 周比较分数。比较 mBSTAT 的各个领域，以确定显示出更大程度恶化的特定技能。
28 名医学生完成了初始模拟课程。15 人在 8 周后返回。模拟课程后立即观察到支气管镜技能显著提高(mBSTAT 评分 3.7±1.2 预测试与 7.0±0.9 后测试，P<0.001)。8 周时 mBSTAT 评分显著恶化(5.7±1.8，P=0.03)，但仍优于基线评分(P=0.002)。在所评估的 4 个领域中，只有精度在测试后和审查评估之间没有任何变化(P=0.14)。其他所有领域在后测和复查之间都表现出明显的恶化趋势。
单次 45 分钟非结构化支气管镜检查模拟课程可显著提高支气管镜检查灵巧性。支气管镜检查灵巧性显著下降，表明在没有支气管镜检查暴露的情况下，重复模拟可能是有价值的。
