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Issa MA, Clementsen PF, Laursen CB, Christiansen IS, Crombag L, Vilmann P, Bodtger U. Added value of EUS-B-FNA to bronchoscopy and EBUS-TBNA in diagnosing and staging of lung cancer. Eur Clin Respir J 2024; 11:2362995. [PMID: 38859948 PMCID: PMC11164041 DOI: 10.1080/20018525.2024.2362995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/29/2024] [Indexed: 06/12/2024] Open
Abstract
Background Bronchoscopy and EBUS are standard procedures in lung cancer work-up but have low diagnostic yield in lesions outside the central airways and hilar/mediastinal lymph nodes. Growing evidence on introducing the EBUS endoscope into the oesophagus (EUS-B) in the same session as bronchoscopy/EBUS gives access to new anatomical areas that can be safely biopsied. Objective To summarize the current evidence of the added value of EUS-B-FNA to bronchoscopy and EBUS-TBNA in lung cancer work-up. Methods A narrative review. Results Few randomized trials or prospective studies are available. Prospective studies show that add-on EUS-B-FNA increases diagnostic yield when sampling abnormal mediastinal lymph nodes, para-oesophageal lung and left adrenal gland. A large retrospective series on EUS-B-FNA from retroperitoneal lymph nodes suggests high diagnostic yield without safety concerns, as do casuistic reports on EUS-B-FNA from mediastinal pleural thickening, pancreatic lesions, ascites fluid and pericardial effusions. No study has systematically assessed both diagnostic yield, safety, patient reported outcomes, adverse events and costs. Conclusion The diagnostic value of add-on EUS-B to standard bronchoscopy and EBUS in lung cancer work-up appears very promising without safety concerns, giving the pulmonologist access to a variety of sites out of reach with other minimally invasive techniques. Little is known on patient-reported outcomes and costs. Future and prospective research should focus on effectiveness aspects to clarify whether overall benefits of add-on EUS-B sufficiently exceed overall downsides.
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Affiliation(s)
- Mohammad A. Issa
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Næstved, Denmark
| | - Paul F. Clementsen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Næstved, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
| | - Christian B. Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ida S. Christiansen
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Næstved, Denmark
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Laurence Crombag
- Department of Respiratory Medicine, University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Vilmann
- Gastro Unit, Copenhagen University Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Næstved, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
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Dietrich CF, Bugalho A, Carrara S, Clementsen PF, Dong Y, Hocke M, Kolekar SB, Konge L, Ignee A, Löwe A, Jenssen C. Controversies in endobronchial ultrasound. Endosc Ultrasound 2024; 13:6-15. [PMID: 38947115 PMCID: PMC11213616 DOI: 10.1097/eus.0000000000000034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Endobronchial ultrasound (EBUS) is a minimally invasive highly accurate and safe endoscopic technique for the evaluation of mediastinal lymphadenopathy and mediastinal masses including centrally located lung tumors. The combination of transbronchial and transoesophageal tissue sampling has improved lung cancer staging, reducing the need for more invasive and surgical diagnostic procedures. Despite the high level of evidence regarding EBUS use in the aforementioned situations, there are still challenges and controversial issues such as follows: Should informed consent for EBUS and flexible bronchoscopy be different? Is EBUS able to replace standard bronchoscopy in patients with suspected lung cancer? Which is the best position, screen orientation, route of intubation, and sedation/anesthesia to perform EBUS? Is it advisable to use a balloon in all procedures? How should the operator acquire skills and how should competence be ensured? This Pro-Con article aims to address these open questions.
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Affiliation(s)
- Christoph F. Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem and Permancence, Bern, Switzerland
| | - Antonio Bugalho
- Pulmonology Department, CUF Tejo Hospital and CUF Descobertas Hospital, Lisbon, Portugal
- Comprehensive Health Research Centre, Chronic Diseases Research Center (CEDOC), NOVA Medical School, Lisbon, Portugal
| | - Silvia Carrara
- IRCCS Humanitas Research Hospital – Endoscopic Unit, Department of Gastroenterology, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
- Respiratory Research Unit PLUZ, Zealand University Hospital Roskilde/Naestved, Denmark
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Michael Hocke
- Medical Department II, Helios Klinikum Meiningen, Meiningen, Germany
| | - Shailesh Balasaheb Kolekar
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - André Ignee
- Department of Internal Medicine – Gastroenterology & Rheumatology, Klinikum Wuerzburg Mitte, Wuerzburg, Germany
| | - Axel Löwe
- Department of Internal Medicine, Krankenhaus Märkisch Oderland GmbH, Strausberg/Wriezen, Germany
- Brandenburg Institute for Clinical Ultrasound (BICUS) at Medical University Brandenburg “Theodor Fontane,” Neuruppin, Germany
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland GmbH, Strausberg/Wriezen, Germany
- Brandenburg Institute for Clinical Ultrasound (BICUS) at Medical University Brandenburg “Theodor Fontane,” Neuruppin, Germany
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Biondini D, Tinè M, Semenzato U, Daverio M, Scalvenzi F, Bazzan E, Turato G, Damin M, Spagnolo P. Clinical Applications of Endobronchial Ultrasound (EBUS) Scope: Challenges and Opportunities. Diagnostics (Basel) 2023; 13:2565. [PMID: 37568927 PMCID: PMC10417616 DOI: 10.3390/diagnostics13152565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/20/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Endobronchial Ultrasound (EBUS) has been widely used to stage lung tumors and to diagnose mediastinal diseases. In the last decade, this procedure has evolved in several technical aspects, with new tools available to optimize tissue sampling and to increase its diagnostic yield, like elastography, different types of needles and, most recently, miniforceps and cryobiopsy. Accordingly, the indications for the use of the EBUS scope into the airways to perform the Endobronchial Ultrasound-TransBronchial Needle Aspiration (EBUS-TBNA) has also extended beyond the endobronchial and thoracic boundaries to sample lesions from the liver, left adrenal gland and retroperitoneal lymph nodes via the gastroesophageal tract, performing the Endoscopic UltraSound with Bronchoscope-guided Fine Needle Aspiration (EUS-B-FNA). In this review, we summarize and critically discuss the main indication for the use of the EBUS scope, even the more uncommon, to underline its utility and versatility in clinical practice.
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Affiliation(s)
- Davide Biondini
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
- Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Mariaenrica Tinè
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Umberto Semenzato
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Matteo Daverio
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Francesca Scalvenzi
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Erica Bazzan
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Graziella Turato
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Marco Damin
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
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Pietersen PI, Bhatnagar R, Rahman NM, Maskell N, Wrightson JM, Annema J, Crombag L, Farr A, Tabin N, Slavicky M, Skaarup SH, Konge L, Laursen CB. Evidence-based training and certification: the ERS thoracic ultrasound training programme. Breathe (Sheff) 2023; 19:230053. [PMID: 37492346 PMCID: PMC10365077 DOI: 10.1183/20734735.0053-2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/25/2023] [Indexed: 07/27/2023] Open
Abstract
Thoracic ultrasound has developed into an integral part of the respiratory physician's diagnostic and therapeutic toolbox, with high diagnostic accuracy for many diseases causing acute or chronic respiratory symptoms. However, it is vitally important that the operator has received the appropriate education and training to ensure a systematic and thorough examination, correct image interpretation, and that they then have the appropriate skills to integrate all the findings for patient benefit. In this review, we present the new European Respiratory Society thoracic ultrasound training programme, including a discussion of curriculum development, its implementation, and trainee evaluation. This programme enables participants to gain competence in thoracic ultrasound through structured, evidence-based training with robustly validated assessments and certification. The training programme consists of three components: an online, theoretical part (part 1), which is accessible all year; a practical course (part 2), with four courses held each year (two online courses and two on-site courses); and an examination (part 3) comprising an objective structured clinical examination (OSCE), which is hosted each year at the European Respiratory Society Congress.
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Affiliation(s)
- Pia Iben Pietersen
- Department of Radiology, Odense University Hospital – Svendborg, UNIFY – Research and Innovation Unit of Radiology, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, SimC – Simulation Center, Odense University Hospital, Odense, Denmark
| | - Rahul Bhatnagar
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Najib M. Rahman
- University of Oxford, Oxford NIHR Biomedical Research Centre, Oxford Centre for Respiratory Medicine, Oxford, UK
| | - Nick Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - John M. Wrightson
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jouke Annema
- Department of Respiratory Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Laurence Crombag
- Department of Respiratory Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Amy Farr
- Education Department, European Respiratory Society (ERS), Lausanne, Switzerland
| | - Nathalie Tabin
- Education Department, European Respiratory Society (ERS), Lausanne, Switzerland
| | - Marek Slavicky
- Education Department, European Respiratory Society (ERS), Lausanne, Switzerland
| | - Søren Helbo Skaarup
- Department of Respiratory Medicine and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - Christian B. Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN) - Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Nielsen MS, Clausen JH, Hoffmann-Petersen J, Konge L, Nielsen AB. Can virtual-reality simulation ensure transthoracic echocardiography skills before trainees examine patients? INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2022; 13:267-273. [PMID: 36196646 PMCID: PMC9904995 DOI: 10.5116/ijme.6321.8e5d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES This study aimed to develop and gather the validity evidence for a standardised simulation-based skills test in transthoracic echocardiography and to establish a credible pass/fail score. METHODS Experts developed a virtual-reality simulator test in cardiology, medical education and simulation-based education. Thirty-six physicians with different experiences in transthoracic echocardiography completed the test at Odense University Hospital, Denmark. The performances of novice, intermediate and experienced participants were compared using the Bonferroni post hoc test. Cronbach's alpha was used to determine the internal consistency reliability of the test. The consistency of performance was analysed using the intraclass correlation coefficient. A pass/fail score was established using the contrasting groups' standard-setting method. RESULTS We developed a test with high consistent reliability (Alpha = .81), 95% CI [.69, .89]. In both cases, the performers' level was consistent, fitting others at the same level of experience (intraclass correlation r(35)=.81, p<.001). A pass/fail score of 48/50 points was established based on the mean test score of novice and experienced physicians. CONCLUSIONS We developed a standardised virtual-reality simulation-based test of echocardiography skills with the ability to distinguish between participants with different levels of transthoracic echocardiography experience. This test could direct a mastery learning training program where trainees practise until they reach the pre-defined level and secure a higher level of competency to ensure quality and safety for patients.
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Affiliation(s)
| | - Jesper H. Clausen
- SimC - Simulation Center, Odense University Hospital, Odense, Denmark
| | | | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Copenhagen, Denmark
| | - Anders B. Nielsen
- SimC - Simulation Center, Odense University Hospital, Odense, Denmark
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Toennesen LL, Vindum HH, Risom E, Pulga A, Nessar RM, Arshad A, Christophersen A, Konge L, Clementsen PF. Learning Curves for Electromagnetic Navigation Bronchoscopy Using CUSUM Analysis. J Bronchology Interv Pulmonol 2022; 29:164-170. [PMID: 34561367 DOI: 10.1097/lbr.0000000000000815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/31/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Electromagnetic navigation bronchoscopy (ENB) is a relatively new and technically demanding procedure for the guidance of bronchoscopic biopsy to help locate small lung lesions. The results in experienced hands are well described. However, we do not know the results in unexperienced hands-in other words, we have no knowledge about how fast you can learn the procedure. AIM The aim of this study was to draw learning curves for beginners in ENB using Cumulated Sum (CUSUM) analysis, a method for quantitative evaluation of the learning curves for clinical procedures. METHODS Four operators from 3 centers without prior ENB experience were enrolled. The outcome of consecutive ENB procedures was assessed and classified as either diagnostic or nondiagnostic based on sample adequacy. Learning curves were drawn based on diagnostic yield. RESULTS A total of 215 procedures were assessed. For 2 of the operators (operators 1 and 4), at least 25 to 30 procedures were necessary to obtain competency whereas operators 2 and 3 showed more horizontal learning curves indicating an overweight of diagnostic procedures from the beginning. CONCLUSION Operators achieve competences in ENB at different paces. This must be taken in account when beginners start to learn the procedure. There is a huge need for a structured educational program and a validated test to determine competences.
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Affiliation(s)
| | | | - Ellen Risom
- Department of Pulmonary Medicine, Odense University Hospital, Odense, Denmark
| | - Alexis Pulga
- Department of Pulmonary Medicine, Bispebjerg University Hospital
| | - Rafi M Nessar
- Department of Internal Medicine, Zealand University Hospital, Roskilde
| | - Arman Arshad
- Department of Pulmonary Medicine, Odense University Hospital, Odense, Denmark
| | | | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
| | - Paul F Clementsen
- Department of Internal Medicine, Zealand University Hospital, Roskilde
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen and the Capital Region of Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
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Impact of a Multimodal Simulation-based Curriculum on Endobronchial Ultrasound Skills. ATS Sch 2022; 3:258-269. [PMID: 35924193 PMCID: PMC9341474 DOI: 10.34197/ats-scholar.2021-0046oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 03/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background Currently there is no consensus on ideal teaching method to train novice trainees in EBUS. Simulation-based procedure training allows direct observation of trainees in a controlled environment without compromising patient safety. Objective We wanted to develop a comprehensive assessment of endobronchial ultrasound (EBUS) performance of pulmonary fellows and assess the impact of a multimodal simulation-based curriculum for EBUS-guided transbronchial needle aspiration. Methods Pretest assessment of 11 novice pulmonary fellows was performed using a three-part assessment tool, measuring EBUS-related knowledge, self-confidence, and procedural skills. Knowledge was assessed by 20 multiple-choice questions. Self-confidence was measured using the previously validated EBUS–Subjective Assessment Tool. Procedural skills assessment was performed on Simbionix BRONCH Express simulator and was modeled on a previously validated EBUS–Skills and Task Assessment Tool (EBUS-STAT), to create a modified EBUS-STAT based on internal faculty input via the Delphi method. After baseline testing, fellows participated in a structured multimodal curriculum, which included simulator training, small-group didactics, and interactive problem-based learning sessions, followed by individual debriefing sessions. Posttest assessment using the same three-part assessment tool was performed after 3 months, and the results were compared to study the impact of the new curriculum. Results The mean knowledge score improved significantly from baseline to posttest (52.7% vs. 67.7%; P = 0.002). The mean EBUS–Subjective Assessment Tool confidence scores (maximum score, 50) improved significantly from baseline to posttest (26 ± 7.6 vs. 35.2 ± 6.3 points; P < 0.001). The mean modified EBUS-STAT (maximum score, 105) improved significantly from baseline to posttest (44.8 ± 10.6 [42.7%] vs. 65.3 ± 11.4 [62.2%]; P < 0.001). There was a positive correlation (r = 0.81) between the experience of the test participants and the modified EBUS-STAT scores. Conclusion This study suggests a multimodal simulation-based curriculum can significantly improve EBUS-guided transbronchial needle aspiration–related knowledge, self-confidence, and procedural skills among novice pulmonary fellows. A validation study is needed to determine if skills attained via a simulator can be replicated in a clinical setting.
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Nayahangan L, Clementsen P, Doubleday A, Riddle J, Annema J, Konge L. Developing a simulation-based training curriculum in transesophageal ultrasound with the use of the endobronchial ultrasound-endoscope. Endosc Ultrasound 2022; 11:104-111. [PMID: 35488622 PMCID: PMC9059804 DOI: 10.4103/eus-d-21-00126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
There is an increasing need to focus on how best to train respiratory physicians to perform EUS with bronchoscope-guided fine-needle aspiration biopsy (EUS-B-FNA). At current, training is mostly performed in the clinical environment under expert supervision; however, the advent of simulation-based education now provides a low-risk setting for novice trainees to learn and practice basic endosonography skills from identifying and understanding normal anatomy as well as pathology, maneuvering of endoscope, interpretation of images, and mastering of sampling techniques. In this descriptive educational paper, we used a six-step approach as a framework to describe the development of a structured training program combining EUS-B-FNA with the already well-established certification training program in endobronchial ultrasound transbronchial needle aspiration. This comprehensive training curriculum includes a theoretical course to achieve foundational knowledge, followed by simulation-based training until mastery standards are met, and supervised clinical apprenticeship. All steps should end with an objective assessment to achieve certification. This systematic development will hopefully encourage endosonography leaders and educators to collaborate and implement an evidence-based comprehensive endosonography curriculum that aims to provide the trainee with the essential EUS-B competencies to ensure that lung cancer patients are diagnosed and staged correctly.
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Cold K, Clementsen P. Diagnosis and staging of lung cancer using transesophageal ultrasound: Training and assessment. Endosc Ultrasound 2022; 11:92-94. [PMID: 35488620 PMCID: PMC9059802 DOI: 10.4103/eus-d-21-00129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
OBJECTIVE This systematic review aims to examine the use of standard-setting methods in the context of simulation-based training of surgical procedures. SUMMARY OF BACKGROUND Simulation-based training is increasingly used in surgical education. However, it is important to determine which level of competency trainees must reach during simulation-based training before operating on patients. Therefore, pass/fail standards must be established using systematic, transparent, and valid methods. METHODS Systematic literature search was done in four databases (Ovid MEDLINE, Embase, Web of Science, and Cochrane Library). Original studies investigating simulation-based assessment of surgical procedures with application of a standard setting were included. Quality of evidence was appraised using GRADE. RESULTS Of 24,299 studies identified by searches, 232 studies met the inclusion criteria. Publications using already established standard settings were excluded (N = 70), resulting in 162 original studies included in the final analyses. Most studies described how the standard setting was determined (N = 147, 91%) and most used the mean or median performance score of experienced surgeons (n = 65, 40%) for standard setting. We found considerable differences across most of the studies regarding study design, set-up, and expert level classification. The studies were appraised as having low and moderate evidence. CONCLUSION Surgical education is shifting towards competency-based education, and simulation-based training is increasingly used for acquiring skills and assessment. Most studies consider and describe how standard settings are established using more or less structured methods but for current and future educational programs, a critical approach is needed so that the learners receive a fair, valid and reliable assessment.
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Clementsen PF, Bodtger U, Konge L, Christiansen IS, Nessar R, Salih GN, Kolekar S, Meyer CN, Colella S, Jenssen C, Herth F, Hocke M, Dietrich CF. Diagnosis and staging of lung cancer with the use of one single echoendoscope in both the trachea and the esophagus: A practical guide. Endosc Ultrasound 2021; 10:325-334. [PMID: 33666182 PMCID: PMC8544013 DOI: 10.4103/eus-d-20-00139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Accurate staging of non-small cell lung cancer (NSCLC) is crucial for allocation to surgical, medical or multimodal treatment. EUS and endobronchial ultrasound (EBUS) have gained ground in the diagnosis and staging of lung cancer in addition to radiological imaging (e.g., computed tomography, fluoroscopy, and magnetic resonance imaging), nuclear medicine techniques (e.g. positron emission tomography, PET), combined techniques (e.g., fluorodesoxyglucosepositron emission tomography scanning), and sonographic imaging including conventional transcutaneous mediastinal and lung ultrasound. By using one single echoendoscope in both the trachea and the esophagus, surgical staging procedures (e.g. mediastinoscopy and video assisted thoracoscopy) can be avoided in a considerable proportion of patients with NSCLC.
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Affiliation(s)
- Paul Frost Clementsen
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde; Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde; Department of Respiratory Medicine, Næstved Hospital, Næstved; Institute for Regional Health Research, University of Southern Denmark, Odense C, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ida Skovgaard Christiansen
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Rafi Nessar
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Goran Nadir Salih
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Shailesh Kolekar
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Christian Niels Meyer
- Department of Internal Medicine, Unit of Respiratory Medicine, Zealand University Hospital, Roskilde; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sara Colella
- Pulmonology Unit, "C.G. Mazzoni" Hospital, Ascoli Piceno, Italy
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch-Oderland, Strausberg; Brandenburg Institute for Clinical Ultrasound, Neuruppin, Germany
| | - Felix Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg Heidelberg, Germany
| | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, Germany
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
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Stolz D, Tabin N, Farr A. Harmonisation of respiratory medicine: the success story of European curriculum development. J Thorac Dis 2021; 13:2029-2034. [PMID: 33841990 PMCID: PMC8024833 DOI: 10.21037/jtd.2019.02.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/14/2019] [Indexed: 11/19/2022]
Abstract
In 2005, the European Respiratory Society (ERS) launched a project to harmonise education and training and to address the heterogeneity of respiratory health training across Europe. Since then, various educational activities have been developed for different target audiences. This article will describe the overall methodology and the projects developed over the years, detailing their objectives and target audiences. Moving forward, ERS strives to provide a structure for the continuing professional development of respiratory physicians.
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Affiliation(s)
- Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
| | - Nathalie Tabin
- Education Department, European Respiratory Society, Lausanne, Switzerland
| | - Amy Farr
- Education Department, European Respiratory Society, Lausanne, Switzerland
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13
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Pietersen PI, Laursen CB, Petersen RH, Konge L. Structured and evidence-based training of technical skills in respiratory medicine and thoracic surgery. J Thorac Dis 2021; 13:2058-2067. [PMID: 33841995 PMCID: PMC8024809 DOI: 10.21037/jtd.2019.02.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Within the last decade, the number of technical procedures in respiratory medicine and thoracic surgery has grown and created a higher demand for effective and evidence-based education. Today, trainees are often allowed to perform procedures unsupervised on patients after obtaining a course certificate from a theoretic course and having performed a fixed number of supervised procedures. However, these methods do not ensure adequate competence. Well-structured and effective educational programmes including validated tests are needed to reduce economic expenses, optimize time spend, and ensure patient safety. The aim of this article is to summarize current state of educational strategies for technical procedures within respiratory medicine and thoracic surgery. Thus, to discuss future recommendations for curriculum development and assessment of competences based on Kern’s framework. The approach by Kern consists of six topics, which needs to be considered and evaluated and in order to educate physicians and surgeons most effective and evidence-based. We present a practical guide contributing to future educators’ considerations on (I) problem identification and general needs assessment, (II) targeted needs assessment, (III) goals and objectives, (IV) educational strategies, (V) implementation, and finally (VI) evaluation and feedback.
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Affiliation(s)
- Pia Iben Pietersen
- Regional Center for Technical Simulation, Region of Southern Denmark, Odense, Denmark.,Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Insitute for Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Insitute for Clinical Research, University of Southern Denmark, Odense, Denmark
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Capital Region, Copenhagen, Denmark
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14
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Primhak R. Assessment methods in respiratory medicine training in Europe: current status and future needs. Breathe (Sheff) 2020; 16:190314. [PMID: 32494302 PMCID: PMC7249786 DOI: 10.1183/20734735.0314-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
There is a perceived need for harmonisation of training standards in medicine across Europe. Assessment methodology is a fundamental part of this harmonisation. Assessment may be: summative, measuring competency at the end of training, usually in a pass/fail mode; or formative, assessing strengths and weaknesses during training with a view to optimising performance. A survey of experienced respiratory medicine trainers in Europe was undertaken to discover the formative and summative assessment methods being used, and to explore the use of workplace-based assessments (WBAs). Structured interviews were sought with experienced trainers in adult and paediatric respiratory medicine. 35 trainers from 22 (71%) out of 31 countries were interviewed. The number of types of summative assessments required at the end of training varied from 0 to 4 including clinical (25%), written (44%) and oral (47%) examinations. Four respondents required a research thesis as a proof of clinical competence. WBA was not commonly used. Only 14% of respondents reported using a formal case-based discussion, 20% used a form of multisource feedback and 25% described some form of formal assessment of procedural skills. However, 77% of all respondents expressed a wish to have access to case-based discussion and 72% wanted to have a facility for multisource feedback. The majority also wanted training in the use of these tools. Almost half of the respondents had received no formal training in educational supervision and 80% of all respondents expressed a wish to receive such training. The findings suggest that there is no adequate process of ensuring uniform standards for specialist accreditation in Europe, and demonstrate a need and desire among trainers for more WBA tools and training in their use to be made available.
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Affiliation(s)
- Robert Primhak
- Education Council, European Respiratory Society, Lausanne, Switzerland
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15
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Colt HG, Williamson JP. Training in interventional pulmonology: What we have learned and a way forward. Respirology 2020; 25:997-1007. [PMID: 32453479 DOI: 10.1111/resp.13846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/15/2020] [Accepted: 04/09/2020] [Indexed: 12/01/2022]
Abstract
IP encompasses a complex list of procedures requiring knowledge, technical skills and competence. Modern, learner-centric educational philosophies and an explosion of multidimensional educational tools including manikins, simulators, online resources, social media and formal programs can foster learning in IP, promoting professionalism and a culture of lifelong learning. This paper provides background and guidance to a structured, multidimensional and learner-centric strategy for medical procedural education. Focusing on our experience in IP, we describe how competency-based measures, simulation technology and various teaching modalities contribute to a more uniform learning environment in which patients do not suffer the burdens of procedure-related training.
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Affiliation(s)
- Henri G Colt
- School of Medicine, University of California, Irvine, CA, USA
| | - Jonathan P Williamson
- South Western Sydney Clinical School, Liverpool Hospital, The University of New South Wales, Sydney, NSW, Australia.,MQ Health Respiratory and Sleep, Macquarie University Hospital, Sydney, NSW, Australia
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16
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McCracken DJ, Laursen CB, Barker G, Gleeson FV, Cullen KM, Rahman NM. Thoracic ultrasound competence for ultrasound-guided pleural procedures. Eur Respir Rev 2019; 28:28/154/190090. [PMID: 31871126 DOI: 10.1183/16000617.0090-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/09/2019] [Indexed: 12/27/2022] Open
Abstract
Focused thoracic ultrasound has become essential in the guidance and direction of pleural interventions to reduce unwanted complications and as a result now forms a crucial component of physician training. Current training standards along with assessment methods vary widely, and are often not robust enough to ensure adequate competence.This review assesses the current state of training and assessment of thoracic ultrasound competence in various settings, allowing comparison with alternative competency based programmes. Future directions for training and assessment of thoracic ultrasound competence are discussed.
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Affiliation(s)
- David J McCracken
- Oxford Centre for Respiratory Medicine, Oxford, UK .,Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | | | - Graham Barker
- Nuffield Dept of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Fergus V Gleeson
- Dept of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kathy M Cullen
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford, UK
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17
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Mitchell S, Sehlbach C, Driessen E, Farr A, Grant J, Konge L, Pannetier C, Schut S, Stolz D, Rohde G. Meeting challenges in delivery of patient care: a reflection on the involvement of ERS in CPD of respiratory physicians. Breathe (Sheff) 2019; 15:e97-e103. [PMID: 31777571 PMCID: PMC6876138 DOI: 10.1183/20734735.0172-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
At the end of his mandate, Gernot Rohde (European Respiratory Society (ERS) Education Council Chair 2014–2017) and the ERS Education Council had the opportunity to reflect on the goals achieved over 3 years and the challenges in implementing continuing professional development (CPD) programmes for our respiratory specialists. The third ERS Education Research Seminar took place in Frankfurt, Germany, in June 2017 with >30 international experts in medical education and respiratory medicine. >1 year later, we can now reflect on the ERS Education Seminar, the achievements of the Education Council over 3 years, and the continuing path to better understand the education needs of practicing respiratory medicine specialists. This article reflects on the core principles of medical education and offers a reflection on CPD for respiratory professionals within ERS Education. A reflection on @EuroRespSoc education, a learning pathway for the future: better practice, better physicians, better patientshttp://bit.ly/2XHmr3J
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Affiliation(s)
| | - Carolin Sehlbach
- Dept of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Erik Driessen
- Dept of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Amy Farr
- European Respiratory Society, Lausanne, Switzerland
| | | | - Lars Konge
- Copenhagen University and the Capital Region of Denmark, Centre for Clinical Education, University of Copenhagen, Copenhagen, Denmark
| | | | - Suzanne Schut
- Dept of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Daiana Stolz
- University Hospital Basel, Pulmonary Care Division, Basel, Switzerland
| | - Gernot Rohde
- Respiratory Medicine, Johann Wolfgang Goethe University Hospital, Frankfurt, Germany
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18
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Kuijvenhoven J, Leoncini F, Crombag L, Spijker R, Bonta P, Korevaar D, Annema J. Endobronchial Ultrasound for the Diagnosis of Centrally Located Lung Tumors: A Systematic Review and Meta-Analysis. Respiration 2019; 99:441-450. [DOI: 10.1159/000500363] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/15/2019] [Indexed: 11/19/2022] Open
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19
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Bousema JE, van Dorp M, Hoeijmakers F, Huijbregts IA, Barlo NP, Bootsma GP, van Boven WP, Claessens NJ, Dingemans AMC, Hanselaar WE, Kortekaas RT, Lardenoije JWH, Maessen JG, Schreurs WH, Vissers Y, Youssef-El Soud M, Dijkgraaf MG, Annema J, van den Broek FJ. Guideline adherence of mediastinal staging of non-small cell lung cancer: A multicentre retrospective analysis. Lung Cancer 2019; 134:52-58. [DOI: 10.1016/j.lungcan.2019.05.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/19/2019] [Accepted: 05/29/2019] [Indexed: 12/26/2022]
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20
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Candoli P, Ceron L, Trisolini R, Romagnoli M, Michieletto L, Scarlata S, Galasso T, Leoncini F, Pasini V, Dennetta D, Marchesani F, Zotti M, Corbetta L. Competence in endosonographic techniques. Panminerva Med 2019; 61:249-279. [DOI: 10.23736/s0031-0808.18.03570-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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21
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Pietersen PI, Konge L, Madsen KR, Bendixen M, Maskell NA, Rahman N, Graumann O, Laursen CB. Development of and Gathering Validity Evidence for a Theoretical Test in Thoracic Ultrasound. Respiration 2019; 98:221-229. [PMID: 31137031 DOI: 10.1159/000500146] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/03/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Thoracic ultrasound (TUS) has a high diagnostic accuracy for many common pulmonary diseases, but theoretic knowledge in sonographic physics, thoracic anatomy and physiology, and sonopathologic patterns is required to develop competence. OBJECTIVES The aims of the study were to develop and gather validity evidence for a theoretical test in TUS and to establish a pass/fail standard. METHODS Content was provided based on expert interviews, leading to the creation of 113 initial multiple-choice question (MCQ) items. Consensus was reached on 92 proceeding items through a Delphi process, and items were presented to physicians with different knowledge and experience in TUS. Answers were used for item statistics in order to select the items with the most optimal item discrimination and difficulty (i.e., level I items) to be included in the final test. Mean scores of the novice, intermediate and experienced groups were compared, and a pass/fail score was established using the contrasting groups' standard setting method. RESULTS Item statistics revealed 38 level I items, of which 30 were selected to be included in the final test. The internal consistency was high (Cronbach's alpha = 0.88). Differences in mean scores were 8.6 points (p < 0.001), 6.3 points (p = 0.01), and 14.9 points (p < 0.001) between novices and intermediates, intermediates and experienced, and novices and experienced, respectively. A pass/fail standard of 20 points was established. CONCLUSION The established MCQ test can distinguish between physicians with different levels of competence in TUS and enables an objective, evidence-based approach for assessing the theoretical knowledge of trainees undergoing an educational programme in TUS.
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Affiliation(s)
- Pia Iben Pietersen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark,
- Regional Center for Technical Simulation, Odense University Hospital, Odense, Denmark,
- Institute for Clinical Research, University of Southern Denmark, Odense, Denmark,
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Capital Region of Denmark, Copenhagen, Denmark
| | - Kristian Rørbæk Madsen
- Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark
| | - Morten Bendixen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Najib Rahman
- Oxford Pleural Unit and NIHR Biomedical Research Unit, Oxford University Hospital, Oxford, United Kingdom
| | - Ole Graumann
- Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
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22
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23
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Corbetta L, Patelli M. Executive Summary of Training and Competence Standards for the Interventional Pulmonology Master Program in Italy. J Bronchology Interv Pulmonol 2018; 25:6-8. [PMID: 29261575 PMCID: PMC5753824 DOI: 10.1097/lbr.0000000000000447] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Lorenzo Corbetta
- Department of Experimental and Clinical Medicine, University of Florence.,Division on Interventional Pulmonology, University Hospital of Careggi, Bologna, Italy
| | - Marco Patelli
- Department of Experimental and Clinical Medicine, University of Florence
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24
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Aliberti S, Farr A, Tabin N, Blasi F, Torres A, Woodhead M, Migliori GB, Sotgiu G, Dimopoulos G, Chalmers JD, Ringshausen FC, Loebinger MR, Read R, Rohde G. ERS syllabus for postgraduate training in respiratory infections: a guide for comprehensive training. Breathe (Sheff) 2018; 14:269-275. [PMID: 30519292 PMCID: PMC6269171 DOI: 10.1183/20734735.026218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Respiratory infections, including tuberculosis, represent one of the leading causes of morbidity and mortality across the world. They represent the deadliest communicable diseases causing 3.0 million deaths worldwide in 2016 [1]. The burden of respiratory infections can be unbearable for some health systems: they represent one of the most common reasons for doctor visits, regardless of age and sex [2]. ERS has developed a syllabus for postgraduate training in respiratory infections to guide programme designershttp://ow.ly/xJ0R30m8CYB
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Affiliation(s)
- Stefano Aliberti
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Amy Farr
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Nathalie Tabin
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Francesco Blasi
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Antoni Torres
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Mark Woodhead
- For a full list of the authors' affiliations please see the Acknowledgements section
| | | | - Giovanni Sotgiu
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - George Dimopoulos
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - James D Chalmers
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Felix C Ringshausen
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Michael R Loebinger
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Robert Read
- For a full list of the authors' affiliations please see the Acknowledgements section
| | - Gernot Rohde
- For a full list of the authors' affiliations please see the Acknowledgements section
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25
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Farr A, Gaga M, Welte T, Troosters T, Joos G, Robalo Cordeiro C, Burghuber OC, Brusselle G, Gratziou CG, Bush A, Saraiva I, Pannetier C, Stolz D. The European Respiratory Society: ensuring excellence through education best practice. Eur Respir J 2018; 52:52/3/1801248. [PMID: 30219751 DOI: 10.1183/13993003.01248-2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/27/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Amy Farr
- European Respiratory Society, Lausanne, Switzerland
| | - Mina Gaga
- 7th Respiratory Medicine Dept, Athens Chest Hospital Sotiria, Athens, Greece
| | - Tobias Welte
- Pulmonary Medicine, University of Hannover, Hannover, Germany
| | - Thierry Troosters
- Dept of Rehabilitation Sciences, University of Leuven, Leuven, Belgium
| | - Guy Joos
- Dept of Respiratory Diseases, Ghent University Hospital, Ghent, Belgium
| | | | | | - Guy Brusselle
- Dept of Respiratory Diseases, Ghent University Hospital, Ghent, Belgium
| | | | - Andrew Bush
- Paediatrics Section, National Heart and Lung Institute, London, UK.,Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | | | - Daiana Stolz
- Pulmonary Care Division, University Hospital Basel, Basel, Switzerland
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26
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Nayahangan LJ, Stefanidis D, Kern DE, Konge L. How to identify and prioritize procedures suitable for simulation-based training: Experiences from general needs assessments using a modified Delphi method and a needs assessment formula. MEDICAL TEACHER 2018; 40:676-683. [PMID: 29938547 DOI: 10.1080/0142159x.2018.1472756] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Simulation-based training (SBT) is a revolutionary addition to the education of residents in different specialties. However, the selection of training programs is often reliant on commercially available equipment or on experiential notions, local interests or coincidence. The first step to developing training programs should be problem identification and general needs assessment to ensure that these are aligned with current trainee needs. We describe a stepwise approach to performing a needs assessment following the Delphi process and using a needs assessment formula (NAF) to prioritize technical procedures for simulation training. This technique relies on a panel of experts to gather information and achieve a convergence of opinion. We used three rounds of survey iterations. Round 1: A brainstorming phase to gather all procedures that a newly qualified resident should be able to perform. Round 2: Rating and preliminary prioritization with a NAF including frequency of the procedure, number of doctors, impact, and feasibility. Round 3: Elimination and final prioritization of procedures. The needs assessment identifies and prioritizes procedures for simulation training. It can guide medical educators in the planning of SBT programs to address current trainee needs with the aim of improving the education and training of future doctors.
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Affiliation(s)
- Leizl Joy Nayahangan
- a Copenhagen Academy for Medical Education and Simulation (CAMES) , University of Copenhagen and The Capital Region of Denmark , Copenhagen , Denmark
| | | | - David E Kern
- c School of Medicine , Johns Hopkins University , Baltimore , MD , USA
| | - Lars Konge
- a Copenhagen Academy for Medical Education and Simulation (CAMES) , University of Copenhagen and The Capital Region of Denmark , Copenhagen , Denmark
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27
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Reply: Diagnostic Yield of EBUS-TBNA During the Learning Curve. J Bronchology Interv Pulmonol 2018; 25:e27-e28. [PMID: 29561405 DOI: 10.1097/lbr.0000000000000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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29
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Efficacy of Endobronchial Ultrasound-Transbronchial Needle Aspiration Virtual-Reality Simulator Training. J Bronchology Interv Pulmonol 2017; 25:e2-e3. [PMID: 29261582 DOI: 10.1097/lbr.0000000000000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Bugalho A, de Santis M, Slubowski A, Rozman A, Eberhardt R. Trans-esophageal endobronchial ultrasound-guided needle aspiration (EUS-B-NA): A road map for the chest physician. Pulmonology 2017; 24:S2173-5115(17)30162-8. [PMID: 29242047 DOI: 10.1016/j.rppnen.2017.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/15/2017] [Indexed: 12/25/2022] Open
Abstract
The endobronchial ultrasound (EBUS) scope has been increasingly used in the gastrointestinal tract (EUS-B). Scientific data proves its efficacy and safety to provide a complete lung cancer staging, when combined with EBUS-TBNA, and in the diagnosis of para-esophageal lesions. There are multiple barriers to start performing EUS-B but probably the most important ones are related to knowledge and training, so new operators should follow a structured training curriculum. This review aims to reflect the best current knowledge regarding EUS-B and provide a road map to assist those who are incorporating the technique into their clinical practice.
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Affiliation(s)
- A Bugalho
- Pulmonology Unit, CUF Infante Santo Hospital, CUF Descobertas Hospital, Instituto CUF Oncologia (I.C.O.), Portugal; Chronic Diseases Research Center (CEDOC), NOVA Medical School, Lisbon, Portugal.
| | - M de Santis
- Serviço de Pneumologia, Instituto Português de Oncologia (IPO), Coimbra, Portugal.
| | - A Slubowski
- Endoscopy Unit, John Paul II Hospital, Krakow and Endoscopy Unit, Pulmonary Hospital Zakopane, Poland.
| | - A Rozman
- University Clinic of Pulmonary and Allergic Diseases Golnik, Slovenia.
| | - R Eberhardt
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research (DZL), Heidelberg, Germany.
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31
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Leong P, Deshpande S, Irving LB, Bardin PG, Farmer MW, Jennings BR, Steinfort DP. Endoscopic ultrasound fine-needle aspiration by experienced pulmonologists: a cusum analysis. Eur Respir J 2017; 50:50/5/1701102. [PMID: 29097432 DOI: 10.1183/13993003.01102-2017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/01/2017] [Indexed: 11/05/2022]
Abstract
Endobronchial ultrasound transbronchial needle aspiration (EBUS TBNA) is an established, minimally invasive way to sample intrathoracic abnormalities. The EBUS scope can be passed into the oesophagus to perform endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA). In cases of suspected lung cancer, a combination of the two techniques is now recommended by consensus guidelines. EBUS TBNA is usually performed by pulmonologists; however, the learning curve for EUS-B-FNA, which may be performed during the same procedure, has not been described.A multicentre, observational Australian study, using prospectively collected data from three experienced pulmonologists was conducted. Cumulative sum (cusum) analysis was used to generate visual learning curves.A total of 152 target lesions were sampled in 137 patients, with an overall sensitivity for malignancy of 94.8%. The sensitivity for malignant lesions outside of the 2009 International Association for the Study of Lung Cancer lymph node map (largely intraparenchymal lesions) was 92.9%. All three operators were competent by conventional cusum criteria. There was one case of pneumothorax, and no episodes of mediastinitis or oesophageal perforation were observed.Our data suggest that experienced pulmonologists can safely and accurately perform EUS-B-FNA, with a high diagnostic sensitivity for both lymph node and non-nodal lesions.
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Affiliation(s)
- Paul Leong
- Monash Lung and Sleep, Monash Health, Clayton, Australia .,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia.,Dept of Respiratory Medicine, Melbourne Health, Parkville, Australia
| | | | - Louis B Irving
- Dept of Respiratory Medicine, Melbourne Health, Parkville, Australia
| | - Philip G Bardin
- Monash Lung and Sleep, Monash Health, Clayton, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Michael W Farmer
- Monash Lung and Sleep, Monash Health, Clayton, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | | | - Daniel P Steinfort
- Dept of Respiratory Medicine, Melbourne Health, Parkville, Australia.,Dept of Medicine, University of Melbourne, Melbourne, Australia
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32
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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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