Department of Pulmonary and Critical Care Medicine, University of Cincinnati Medical Center, Cincinnati, OH.
Department of Pulmonary and Critical Care Medicine, Emory University, Atlanta, GA.
J Bronchology Interv Pulmonol. 2023 Jul 1;30(3):252-257. doi: 10.1097/LBR.0000000000000873.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become standard for the diagnosis of lung cancer, and there is an increasing need for procedural competence in trainees. We evaluate a low-cost, gelatin-based EBUS-TBNA training simulator to assess pulmonary fellows' baseline skills and facilitate procedural development.
A low-cost ($30) gelatin-based, high-fidelity simulator was created to represent the airways, major vessels, and lymph node stations essential to identify for EBUS-TBNA. Trainees had a baseline skills assessment using the simulator and were then provided a 1-hour didactic session on EBUS-TBNA and additional practice time with the simulator. Trainees then underwent a postsimulation skills assessment using a modified endobronchial ultrasound (EBUS)-Skills and Tasks Assessment Tool (STAT) performance assessment tool. Simulator fidelity and trainee procedural confidence was assessed using a 10-point scale.
Ten fellows received training on the EBUS-TBNA simulator. First-year trainees scored the lowest on the 18-point performance scale with a mean score of 9, while third-year trainees scored highest with a mean score of 17.5. Mean 18-point performance score improvement after simulator training and didactics was 4.31 points for all trainees with the largest change in first-year trainees amounting to 8.25 points. First-year trainees experienced the greatest improvement in EBUS procedural confidence by a mean of 2.5 points on a 10-point confidence survey.
A low-cost EBUS simulator effectively differentiated early and advanced learners based on graded procedural performance scores. Simulation-based practice significantly improved learners' procedural performance, and the degree of improvement correlated with learner inexperience. The simulation significantly increased early learner confidence in EBUS-TBNA technique.
支气管内超声引导经支气管针吸活检术（EBUS-TBNA）已成为诊断肺癌的标准方法，培训生对程序能力的需求也在不断增加。我们评估了一种低成本、基于明胶的 EBUS-TBNA 培训模拟器，以评估肺研究员的基线技能并促进程序开发。
创建了一种低成本（30 美元）、基于明胶的高保真模拟器，以代表气道、大血管和淋巴结站，这些是识别 EBUS-TBNA 所必需的。学员使用模拟器进行基线技能评估，然后提供 1 小时的 EBUS-TBNA 教学课程和额外的模拟器练习时间。然后，学员使用改良的支气管内超声（EBUS）-技能和任务评估工具（STAT）绩效评估工具进行模拟后技能评估。使用 10 分制评估模拟器保真度和学员程序信心。
10 名研究员接受了 EBUS-TBNA 模拟器的培训。第一年的学员在 18 分的表现量表上得分最低，平均得分为 9 分，而第三年的学员得分最高，平均得分为 17.5 分。所有学员在模拟器培训和教学后的平均 18 分表现评分提高了 4.31 分，第一年学员的变化最大，达到 8.25 分。第一年学员在 EBUS 程序信心方面的最大改善是在 10 分信心调查中平均提高了 2.5 分。
一种低成本的 EBUS 模拟器根据分级程序表现评分有效地区分了早期和高级学习者。基于模拟的实践显著提高了学员的程序表现，而提高的程度与学员的经验不足相关。模拟显著增加了早期学员对 EBUS-TBNA 技术的信心。
