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Tokuno J, Fried GM. Digital Education in General Thoracic Surgery: A Narrative Review. Ann Thorac Surg 2023; 115:787-794. [PMID: 35561802 DOI: 10.1016/j.athoracsur.2022.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/23/2022] [Accepted: 04/13/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Since advanced technologies were introduced into surgical education, a variety of new programs have been developed. However, a comprehensive review of digital education in general thoracic surgery has not been performed. This narrative review was conducted was to identify the current applications of digital education in general thoracic surgery. METHODS A literature search was performed using keywords related to general thoracic surgery and digital education, including e-learning and virtual simulation, up to September 2021. Studies published in English investigating the effect of digital education in general thoracic surgery were included. RESULTS Thirteen studies met the criteria. The settings were in undergraduate (n = 6) and postgraduate education (residency) (n = 5) and mixed audience with other disciplines (n = 2). Theoretical knowledge (n = 5), technical skills (n = 4), and both knowledge and technical skills (n = 4) were the stated educational objectives for the studies. The didactic materials were transferred to hardware, software, or online platforms and delivered with multimedia materials. Technical skills training for bronchoscopy and chest tube insertion (n = 5) were offered using virtual reality and computer-based simulations. Subjective evaluation was done in 10 studies. Although after the digital education training there was observed improvement in knowledge or skills in 8 studies, studies were not designed to test for superiority compared with controls through randomized controlled studies. CONCLUSIONS This review summarizes the current applications of digital education in general thoracic surgery and helps establish the needs for future studies in this field.
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Affiliation(s)
- Junko Tokuno
- Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine and Health Science, Montreal, Quebec, Canada
| | - Gerald M Fried
- Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine and Health Science, Montreal, Quebec, Canada; Department of Surgery, McGill University, Montreal, Quebec, Canada.
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2
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Novel Cost-effective D.I.Y. Gelatin Model for Endobronchial Ultrasound-guided Transbronchial Needle Aspiration Simulation Training. J Bronchology Interv Pulmonol 2021; 27:301-303. [PMID: 32960859 DOI: 10.1097/lbr.0000000000000709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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3
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Tremblay A, Chee AC, Dhaliwal I, Dumoulin E, Gillson A, MacEachern PR, Mitchell M, Schieman C, Stollery D, Li P, Fortin M, Tyan CC, Vakil E, Hergott C. Protocol for the Stather Canadian Outcomes Registry for Chest ProcedurEs (SCOPE). BMJ Open Respir Res 2021; 8:8/1/e000834. [PMID: 33509788 PMCID: PMC7845675 DOI: 10.1136/bmjresp-2020-000834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/11/2021] [Accepted: 01/16/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction The Stather Canadian Outcomes registry for chest ProcedurEs (SCOPE registry) is a Canadian multicentre registry of chest procedures. Methods and analysis The SCOPE registry is designed as a multicentre prospective database of specific bronchoscopic or other pulmonary procedures. Each procedure of interest will be associated with a registry module, and data capture designed to evaluate effectiveness of procedures on relevant patient outcomes. Participating physicians will be asked to enter data for all procedures performed in a given module. The anonymised dataset will be housed in a web-based electronic secure database. Specific modules included will be based on participating physician suggestions, capacity and consensus of the steering committee and relevance of hypotheses/research potential. Ethics and dissemination The central registry is under approval from the Conjoint Health Research Ethics Board at the University of Calgary. We aim for registry data to lead to publication of manuscripts in international medical journals as the primary mode of dissemination. Data may also be used by local investigators for personal and/or institutional quality control purposes as well as to inform health policies. Data requests from non-participating investigators for use under ethics approved research protocols can be considered.
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Affiliation(s)
- Alain Tremblay
- Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alex C Chee
- Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Ashley Gillson
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Michael Mitchell
- Medicine, University of Western Ontario, London, Ontario, Canada
| | - Colin Schieman
- Surgery, University of Calgary, Calgary, Alberta, Canada
| | | | - Pen Li
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Marc Fortin
- Respiratory Medicine, Universite Laval, Quebec, Québec, Canada
| | - Chung C Tyan
- Medicine, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Erik Vakil
- Medicine, University of Calgary, Calgary, Alberta, Canada
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Villanueva C, Xiong J, Rajput S. Simulation-based surgical education in cardiothoracic training. ANZ J Surg 2019; 90:978-983. [PMID: 31828909 DOI: 10.1111/ans.15593] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/05/2019] [Accepted: 10/28/2019] [Indexed: 01/17/2023]
Abstract
Simulation has emerged as a feasible adjunct to surgical education and training for most specialties. It provides trainees with an immersive, realistic way to learn a variety of skills in a safe environment with the end goal of improving patient safety. There are three broad types of simulators: full mannequin simulators, part-task trainers or bench models and virtual reality systems. This review aims to describe the current use of simulation in cardiothoracic surgical education and training. We identified multiple procedures that can be simulated in cardiothoracic surgery using a combination of the above simulators, three-dimensional printing and computer-based simulation. All studies that assessed the efficacy of simulators showed that simulation enhances learning and trainee performance allowing for repetitive training until the acquisition of competence but further research into how it translates into the operating theatre is required. In Australia, cardiac surgery simulation is not yet part of the training curricula, but simulators are available for certain tasks and procedures.
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Affiliation(s)
- Claudia Villanueva
- General Surgery Unit, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jess Xiong
- General Surgery Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Siddharth Rajput
- General Surgery Unit, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
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Kim S, Shin B, Lee H, Ha JH, Lee K, Um SW, Kim H, Jeong BH. Are there differences among operators in false-negative rates of endosonography with needle aspiration for mediastinal nodal staging of non-small cell lung cancer? BMC Pulm Med 2019; 19:14. [PMID: 30642321 PMCID: PMC6332520 DOI: 10.1186/s12890-018-0774-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 12/28/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Endosonography with needle aspiration (EBUS/EUS-NA) is recommended as the first choice for mediastinal nodal assessment in non-small cell lung cancer (NSCLC). It is important to maintain adequate negative predictive value of the procedure to avoid unnecessary additional surgical staging, but there are few studies on the influence of operator-related factors including competency on false negative results. This study aims to compare the false negative rate of individual operators and whether it changes according to accumulation of experience. METHODS This is a retrospective study of NSCLC patients who were N0/N1 by EBUS/EUS-NA and confirmed by pathologic staging upon mediastinal lymph node dissection (n = 705). Patients were divided into a false negative group (finally confirmed as pN2/N3) and a true negative group (pN0/N1). False negative rates of six operators and whether these changed according to accumulated experience were analyzed. RESULTS There were 111 (15.7%) false negative cases. False negative rates among six operators ranged from 8.3 to 21.4%; however, there were no statistical differences before and after adjustment for patient characteristics and procedure-related factors (P = 0.346 and P = 0.494, respectively). In addition, false negative rates did not change as each operator accumulated experience (P for trend = 0.632). CONCLUSIONS Our data suggest that there would be no difference in false negative rates regardless of which operator performs the procedure assuming that the operators have completed a certain period of observation and have performed procedures under the guidance of an expert.
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Affiliation(s)
- Sukyeon Kim
- Division of Pulmonary Medicine, Department of Internal medicine, Hangang Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Republic of Korea
| | - Beomsu Shin
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jick Hwan Ha
- Division of Pulmonology, Critical Care and Sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyungjong Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Sang-Won Um
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351, Republic of Korea.
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Corbetta L, Arru LB, Mereu C, Pasini V, Patelli M. Competence and training in interventional pulmonology. Panminerva Med 2018; 61:203-231. [PMID: 30394710 DOI: 10.23736/s0031-0808.18.03562-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Interventional pulmonology (IP) is experiencing a rapid evolution of new technologies. There is a need to develop structured training programs, organized in high volume expert centers in order to improve trainee education, and including the development of validated metrics for their competency assessment. Concerning teaching methods, a gradual progression from theory to practice, using new teaching techniques, including live sessions and low and high-fidelity simulation, flipped classroom models and problem-based learning (PBL) exercises would provide a training setting more suitable for our current need to improve skills and update professionals. Training programs should be learner-centered and competence-oriented, as well as being based on a spiral-shaped approach in which the same subject is addressed many times, from new and different perspectives of knowledge, ability, behavior and attitude, until the trainee has demonstrated a high degree of skill and professionalism. Furthermore there is a need to standardize the training programs as guide for physicians wishing to undertake a gradual and voluntary improvement of their own competencies, and assist those planning and organizing training programs in IP. The article includes a general part on core curriculum contents, innovative training methods and simulation, and introduces the following articles on the skills that the Interventional Pulmonologist must master in order to perform the different procedures. This monography should be considered a starting point that will evolve over time and results in better training for practitioners and better care for our patients. The task of establishing a trainee's competence to practice independently as an Interventional Pulmonologist remains the responsibility of the IP fellowship program director and faculty, who validate logbooks and assess competence for each procedure. These standards need to be reviewed and approved by national and International Scientific Societies and Healthcare Institutions with the aim to improve, disseminate and incorporate them in healthcare programs.
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Affiliation(s)
- Lorenzo Corbetta
- Unit of Interventional Pulmonology, Department of Experimental and Clinical Medicine, University Hospital of Careggi, University of Florence, Florence, Italy -
| | - Luigi B Arru
- Council of Health of the Region Sardinia, Cagliari, Italy
| | - Carlo Mereu
- Unit of Pneumology, ASL 2 Savonese, Savona, Italy
| | - Valeria Pasini
- Interventional Pulmonary Program, University of Florence, Florence, Italy
| | - Marco Patelli
- Unit of Interventional Pulmonology, University of Florence and Bologna, Florence, Italy
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Ong ASQ, Tan AH, Anantham D, Sharma K, Tan S, Lapperre TS, Tham KY, Sultana R, Koh MS. Impact of simulation training on performance and outcomes of endobronchial ultrasound-guided transbronchial needle aspiration performed by trainees in a tertiary academic hospital. J Thorac Dis 2018; 10:5621-5635. [PMID: 30416813 DOI: 10.21037/jtd.2018.08.76] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has a high diagnostic yield and low complication rate. Whilst it has been included in international guidelines for the diagnosis and staging of lung cancer, current results are mostly based on EBUS experts performing EBUS-TBNA in centres of excellence. The impact of simulation training on diagnostic yield, complications, scope damage and repair cost in a real-world teaching hospital is unclear. Methods A review of our hospital EBUS-TBNA registry from August 2008 to December 2016 was performed. A positive diagnosis was defined as a confirmed histological or microbiological diagnosis based on EBUS sampling. Complications were classified as major or minor according to the British Thoracic Society guidelines. In addition, we assessed the cost of repairs for scope damage before and after simulation training was implemented. Using CUSUM analysis, the learning curves of individual trainees and the institution were plotted. Results There were 608 EBUS-TBNA procedures included in the study. The number of procedures performed by trainees who underwent conventional training was 331 and those who underwent simulation training performed 277 procedures. Diagnostic yield for trainees without simulation training was 88.2% vs. 84.5% for trainees with simulation training (P=0.179). There was no statistical difference in the diagnostic yield between the groups of trainees (OR: 0.781, 95% CI: 0.418-1.460, P=0.438) after adjusting for risk factors. There was an increase in overall complications from 13.6% to 16.6% (OR: 2.247, 95% CI: 1.297-3.891, P=0.004) after introduction of the simulation training, but a trend to decrease in major complications 3.6% to 0.7% (P=0.112). The cost for scope repairs for the trainees without simulation training was SGD 413.88 per procedure vs. SGD 182.79 per procedure for the trainees with simulation training, with the mean difference being SGD 231.09 per procedure (95% CI: 178.40-640.60, P=0.268). CUSUM analysis showed an increasing learning curve for the trainees with simulation training after an initial competency period. Conclusions There was no statistical difference in diagnostic yield from EBUS-TBNA and cost of scope damage after simulation training was introduced into our training program. Interestingly, there was an increase in minor complications. CUSUM analysis can provide additional information on institutional learning curves. The value of simulation training in EBUS-TBNA remains uncertain.
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Affiliation(s)
| | - Aik Hau Tan
- Duke-National University of Singapore Medical School, Singapore.,Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Devanand Anantham
- Duke-National University of Singapore Medical School, Singapore.,Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Kiran Sharma
- Department of General Medicine, Sengkang General Hospital, Singapore
| | - Shera Tan
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Therese Sophie Lapperre
- Duke-National University of Singapore Medical School, Singapore.,Pulmonary Department, Bispebjerg Hospital, Copenhagen, Denmark
| | - Kah Yee Tham
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Rehena Sultana
- Duke-National University of Singapore Medical School, Singapore
| | - Mariko Siyue Koh
- Duke-National University of Singapore Medical School, Singapore.,Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
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Goudsouzian LK, Riola P, Ruggles K, Gupta P, Mondoux MA. Integrating cell and molecular biology concepts: Comparing learning gains and self-efficacy in corresponding live and virtual undergraduate laboratory experiences. BIOCHEMISTRY AND MOLECULAR BIOLOGY EDUCATION : A BIMONTHLY PUBLICATION OF THE INTERNATIONAL UNION OF BIOCHEMISTRY AND MOLECULAR BIOLOGY 2018; 46:361-372. [PMID: 29984456 DOI: 10.1002/bmb.21133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/29/2018] [Accepted: 04/30/2018] [Indexed: 06/08/2023]
Abstract
Multiple pedagogical approaches, such as experimental experiences or computer-based activities, have been shown to increase student learning and engagement. We have developed a laboratory module that includes both a traditional "live" experimental component and a student-designed "virtual" computer simulation component. This laboratory employs the mating pathway of Saccharomyces cerevisiae (yeast) to demonstrate four fundamental cell and molecular biology concepts: cell signaling, cytoskeleton, cell cycle, and cell cycle checkpoints. In the live laboratory, students add mating pheromone to cultures, then measure changes in cell division and morphology characteristics of the S. cerevisiae mating response. We also developed a "virtual" complement to this laboratory. Using the principles of Design Thinking and Agile methodology, we collaborated with an undergraduate Computer Science course to generate two computer simulations which can support the live laboratory or provide a virtual laboratory experience. We assessed how both the live and virtual laboratories contributed to learning gains in analytical skills and course content. Students who performed the simulation alone or the simulation plus live lab demonstrated learning gains, with greater gains for the live lab, but students who performed neither lab did not. Attitudinal assessment demonstrated increased student engagement and self-efficacy after performing the live and virtual labs. © 2018 by The International Union of Biochemistry and Molecular Biology, 46:361-372, 2018.
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Affiliation(s)
- Lara K Goudsouzian
- Departments of Natural Science, DeSales University, Center Valley, Pennsylvania, 18034
| | - Patricia Riola
- Mathematics and Computer Science, DeSales University, Center Valley, Pennsylvania, 18034
| | - Karen Ruggles
- Mathematics and Computer Science, DeSales University, Center Valley, Pennsylvania, 18034
| | - Pranshu Gupta
- Mathematics and Computer Science, DeSales University, Center Valley, Pennsylvania, 18034
| | - Michelle A Mondoux
- Department of Biology, College of the Holy Cross, Worcester, Massachusetts, 01610
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9
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Orr KE, Hamilton SC, Clarke R, Adi MY, Gutteridge C, Suresh P, Freeman SJ. The integration of transabdominal ultrasound simulators into an ultrasound curriculum. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2018; 27:20-30. [PMID: 30774695 DOI: 10.1177/1742271x18762251] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 02/07/2018] [Indexed: 11/16/2022]
Abstract
Introduction Simulation is increasingly used throughout medicine. Within ultrasound, simulators are more established for learning transvaginal and interventional procedures. The use of modern high-fidelity transabdominal simulators is increasing, particularly in centres with large trainee numbers. There is no current literature on the value of these simulators in gaining competence in abdominal ultrasound. The aim was to investigate the impact of a new ultrasound curriculum, incorporating transabdominal simulators into the first year of training in a UK radiology academy. Methods The simulator group included 13 trainees. The preceding cohort of 15 trainees was the control group. After 10 months, a clinical assessment was performed to assess whether the new curriculum resulted in improved ultrasound skills. Questionnaires were designed to explore the acceptability of simulation training and whether it had any impact on confidence levels. Results Trainees who had received simulator-enriched training scored higher in an objective clinical ultrasound assessment, which was statistically significant (p = 0.0463). End confidence scores for obtaining diagnostic images and demonstrating pathology were also higher in the simulation group. All trainees stated that transabdominal simulator training was useful in early training. Conclusions This initial study shows that embedded into a curriculum, transabdominal ultrasound simulators are an acceptable training method that can result in improved ultrasound skills and higher confidence levels. Using simulators early in training could allow trainees to master the basics, improve their confidence, enabling them to get more educational value from clinical ultrasound experience while reducing the impact of training on service provision.
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Affiliation(s)
- K E Orr
- Peninsula Radiology Academy, UK.,Derriford Hospital, Plymouth, UK
| | - S C Hamilton
- Peninsula Radiology Academy, UK.,Derriford Hospital, Plymouth, UK
| | | | - M Y Adi
- Peninsula Radiology Academy, UK
| | | | - P Suresh
- Peninsula Radiology Academy, UK.,Derriford Hospital, Plymouth, UK
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10
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Sehgal IS, Dhooria S, Aggarwal AN, Agarwal R. Training and proficiency in endobronchial ultrasound-guided transbronchial needle aspiration: A systematic review. Respirology 2017; 22:1547-1557. [PMID: 28712157 DOI: 10.1111/resp.13121] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/28/2017] [Accepted: 05/23/2017] [Indexed: 02/01/2023]
Abstract
Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is currently the modality of choice for evaluation of mediastinal lymphadenopathy. However, there is still uncertainty regarding the training methodology and the number of procedures required to attain proficiency in EBUS. Herein, we performed a systematic review of studies selected from PubMed, EmBase and Scopus databases describing the training and assessment of proficiency during EBUS, specifically studies investigating various methods for training, its outcome and the number of procedures required to overcome the learning curve for EBUS. Twenty-seven (simulator-based learning (n = 8), tools for assessing competence in EBUS-TBNA (n = 5) and threshold numbers needed to attain proficiency in EBUS-TBNA (n = 16)) studies were identified. An EBUS simulator accurately stratified individuals based on the level of experience in performing EBUS. Training received on a simulator was comparable with traditional apprentice-based training. Importantly, skills acquired on a simulator could be transferred to real-world patients. The number needed to overcome the initial learning curve of EBUS varied from 10 to 100 in individual studies with a mean of 37-44 procedures. Tools such as EBUS-STAT (EBUS skill and task assessment tool) and EBUSAT (EBUS skill and assessment tool) were effective in evaluating the EBUS trainees. We conclude that an EBUS simulator or EBUS assessment tools can objectively assess the training of an EBUS trainee. Simulator-based training is a useful modality in EBUS training. The number of procedures needed to overcome the initial learning curve is about 40. Centres involved in EBUS training could incorporate simulator-based training in their curriculum before allowing operators to perform EBUS on patients.
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Affiliation(s)
- Inderpaul S Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashutosh N Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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11
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Naur TMH, Konge L, Nayahangan LJ, Clementsen PF. Training and certification in endobronchial ultrasound-guided transbronchial needle aspiration. J Thorac Dis 2017; 9:2118-2123. [PMID: 28840013 DOI: 10.21037/jtd.2017.06.89] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) plays a key role in the staging of lung cancer, which is crucial for allocation to surgical treatment. EBUS-TBNA is a complicated procedure and simulation-based training is helpful in the first part of the long learning curve prior to performing the procedure on actual patients. New trainees should follow a structured training programme consisting of training on simulators to proficiency as assessed with a validated test followed by supervised practice on patients. The simulation-based training is superior to the traditional apprenticeship model and is recommended in the newest guidelines. EBUS-TBNA and oesophageal ultrasound-guided fine needle aspiration (EUS-FNA or EUS-B-FNA) are complementary to each other and the combined techniques are superior to either technique alone. It is logical to learn and to perform the two techniques in combination, however, for lung cancer staging solely EBUS-TBNA simulators exist, but hopefully in the future simulation-based training in EUS will be possible.
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Affiliation(s)
- Therese Maria Henriette Naur
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark.,Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
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12
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Wahidi MM, Herth F, Yasufuku K, Shepherd RW, Yarmus L, Chawla M, Lamb C, Casey KR, Patel S, Silvestri GA, Feller-Kopman DJ. Technical Aspects of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: CHEST Guideline and Expert Panel Report. Chest 2016; 149:816-35. [PMID: 26402427 DOI: 10.1378/chest.15-1216] [Citation(s) in RCA: 246] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/22/2015] [Accepted: 08/13/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Endobronchial ultrasound (EBUS) was introduced in the last decade, enabling real-time guidance of transbronchial needle aspiration (TBNA) of mediastinal and hilar structures and parabronchial lung masses. The many publications produced about EBUS-TBNA have led to a better understanding of the performance characteristics of this procedure. The goal of this document was to examine the current literature on the technical aspects of EBUS-TBNA as they relate to patient, technology, and proceduralist factors to provide evidence-based and expert guidance to clinicians. METHODS Rigorous methodology has been applied to provide a trustworthy evidence-based guideline and expert panel report. A group of approved panelists developed key clinical questions by using the PICO (population, intervention, comparator, and outcome) format that addressed specific topics on the technical aspects of EBUS-TBNA. MEDLINE (via PubMed) and the Cochrane Library were systematically searched for relevant literature, which was supplemented by manual searches. References were screened for inclusion, and well-recognized document evaluation tools were used to assess the quality of included studies, to extract meaningful data, and to grade the level of evidence to support each recommendation or suggestion. RESULTS Our systematic review and critical analysis of the literature on 15 PICO questions related to the technical aspects of EBUS-TBNA resulted in 12 statements: 7 evidence-based graded recommendations and 5 ungraded consensus-based statements. Three questions did not have sufficient evidence to generate a statement. CONCLUSIONS Evidence on the technical aspects of EBUS-TBNA varies in strength but is satisfactory in certain areas to guide clinicians on the best conditions to perform EBUS-guided tissue sampling. Additional research is needed to enhance our knowledge regarding the optimal performance of this effective procedure.
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Affiliation(s)
- Momen M Wahidi
- Duke University Medical Center, Division of Pulmonary and Critical Care Medicine, Durham, NC.
| | - Felix Herth
- Division of Pulmonary and Critical Care Medicine, University of Heidelberg, Heidelberg, Germany
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Lonny Yarmus
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Mohit Chawla
- Division of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Carla Lamb
- Division of Pulmonary and Critical Care Medicine, Lahey Clinic Hospital, Burlington, MA
| | - Kenneth R Casey
- Division of Pulmonary and Critical Care, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Gerard A Silvestri
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC
| | - David J Feller-Kopman
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
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13
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Casal RF. Reply: Sedation Options for Endobronchial Ultrasound-guided Transbronchial Needle Aspiration. Am J Respir Crit Care Med 2015; 192:398. [PMID: 26230242 DOI: 10.1164/rccm.201505-0893le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Roberto F Casal
- 1 Michael E. DeBakey VA Medical Center Houston, Texas and.,2 Baylor College of Medicine Houston, Texas
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Vilmann P, Frost Clementsen P, Colella S, Siemsen M, De Leyn P, Dumonceau JM, Herth FJ, Larghi A, Vazquez-Sequeiros E, Hassan C, Crombag L, Korevaar DA, Konge L, Annema JT. Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg 2015; 48:1-15. [DOI: 10.1093/ejcts/ezv194] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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15
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Vilmann P, Clementsen PF, Colella S, Siemsen M, De Leyn P, Dumonceau JM, Herth FJ, Larghi A, Vazquez-Sequeiros E, Hassan C, Crombag L, Korevaar DA, Konge L, Annema JT. Combined endobronchial and oesophageal endosonography for the diagnosis and staging of lung cancer. Eur Respir J 2015; 46:40-60. [DOI: 10.1183/09031936.00064515] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 04/27/2015] [Indexed: 12/25/2022]
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Hureaux J, Urban T. [Simulation training in pulmonary medicine: Rationale, review of the literature and perspectives]. Rev Mal Respir 2015; 32:969-84. [PMID: 26003195 DOI: 10.1016/j.rmr.2015.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 02/01/2015] [Indexed: 11/26/2022]
Abstract
Training in pulmonary medicine requires the acquisition of a great deal of knowledge, but also technical know-how and interpersonal skills. The prevailing teaching pattern is mentorship. It implies a direct transmission of knowledge, but also entails some drawbacks such as disparity in learning opportunities, subjective evaluation of the trainee and potential risks for patients. There is growing interest in simulation training as a teaching technique, where students practice their skills in a secure environment, then analyse their performance in a debriefing session. It is complementary to other learning methods (abstraction, observation or mentorship) and forms part of an ethical approach: 'never practice on a real patient for the first time'. We have reviewed the literature related to simulation training in pulmonary medicine and in particular for physical examination, technical skills, pathologies, communication with patients and therapeutic education. In most of the studies, simulation training is a way of speeding up students' training - without necessarily yielding better results - and of respecting the procedures. We then present the French regulations and official guidelines regarding the use of this training method in the teaching of medicine. Finally, we shall consider some prospects of this approach for the community of pulmonologists.
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Affiliation(s)
- J Hureaux
- LUNAM université, 49000 Angers, France; Angers plateforme hospitalo-universitaire de simulation en santé, 49933 Angers, France; Service de pneumologie, pôle des spécialités médicales et chirurgicales intégrées, CHU d'Angers, université d'Angers, 4, rue Larrey, 49933 Angers, France; Inserm UMR-S 1066, micro- et nanomédecines biomimétiques, 49933 Angers, France.
| | - T Urban
- LUNAM université, 49000 Angers, France; Angers plateforme hospitalo-universitaire de simulation en santé, 49933 Angers, France; Service de pneumologie, pôle des spécialités médicales et chirurgicales intégrées, CHU d'Angers, université d'Angers, 4, rue Larrey, 49933 Angers, France; Inserm UMR-S 1066, micro- et nanomédecines biomimétiques, 49933 Angers, France
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17
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Konge L, Colella S, Vilmann P, Clementsen PF. How to learn and to perform endoscopic ultrasound and endobronchial ultrasound for lung cancer staging: A structured guide and review. Endosc Ultrasound 2015; 4:4-9. [PMID: 25789278 PMCID: PMC4362002 DOI: 10.4103/2303-9027.151297] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/01/2014] [Indexed: 01/16/2023] Open
Abstract
The learning of transesophageal ultrasound guided fine needle aspiration (FNA) (endoscopic ultrasound-FNA), and endobronchial ultrasound guided transbronchial needle aspiration (endosonography) should be based on the following steps: Acquiring theoretical knowledge, training on simulators, and supervised performance on patients. Each step should be completed by passing a validated exam before proceeding to the next step. This approach will assure basic competency on all levels, and testing also facilitates learning and improves retention. Competence in endosonography can be based on a systematic an easy principle consisting of 2 times six anatomical landmarks.
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Affiliation(s)
- Lars Konge
- Centre for Clinical Education, University of Copenaghen and The Capital Region of Denmark, Copenaghen, Denmark
| | - Sara Colella
- Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Peter Vilmann
- Department of Surgical Gastroenterology, Copenaghen University Hospital, Herlev, Copenaghen, Denmark
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Evaluation of a novel method of teaching endobronchial ultrasound: physician- versus respiratory therapist-proctored simulation training. Can Respir J 2013; 20:243-7. [PMID: 23717823 DOI: 10.1155/2013/846769] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Computer endobronchial ultrasound (EBUS) simulators have been demonstrated to improve trainee procedural skills before attempting to perform EBUS procedures on patients. OBJECTIVE To compare EBUS performance following training with computer simulation proctored by EBUS-trained respiratory therapists versus the same simulation training proctored by an interventional respirologist. METHODS The present analysis was a prospective study of respiratory medicine trainees learning EBUS. Two cohorts of trainees were evaluated using a previously validated method using simulated cases with performance metrics measured by the simulator. Group 1 underwent EBUS training by performing 15 procedures on an EBUS simulator (n=4) proctored by an interventional respirologist. Group 2 received identical training proctored by a respiratory therapist with special training in EBUS (n=10). RESULTS No significant differences between group 1 and group 2 were apparent for the primary outcome measures of total procedure time (15.15±1.34 min versus 14.78±2.88 min; P=0.816), the percentage of lymph nodes successfully identified (88.8±5.4 versus 80.91±8.9; P=0.092) or the percentage of successful biopsies (100.0±0.0 versus 98.75±3.95; P=0.549). The learning curves were similar between groups, and did not show an obvious plateau after 19 simulated procedures in either group. DISCUSSION Acquisition of basic EBUS technical skills can be achieved using computer EBUS simulation proctored by specially trained respiratory therapists or by an interventional respirologist. There appeared to be no significant advantage to having an interventional respirologist proctor the computer EBUS simulation.
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