Effectiveness of Flexible Bronchoscopy Simulation-Based Training

Abstract

BackgroundThe implementation of simulation-based training (SBT) to teach flexible bronchoscopy (FB) skills to novice trainees has increased during the last decade. However, it is unknown whether SBT is effective to teach FB to novices and which instructional features contribute to training effectiveness.Research QuestionHow effective is FB SBT and which instructional features contribute to training effectiveness?Study Design and MethodsWe searched Embase, PubMed, Scopus, and Web of Science for articles on FB SBT for novice trainees until November 10, 2022. We assessed methodologic quality of included studies using a modified version of the Medical Education Research Study Quality Instrument, evaluated risk of bias with relevant tools depending on study design, assessed instructional features, and intended to correlate instructional features to outcome measures.ResultsWe identified 14 studies from an initial pool of 544 studies. Eleven studies reported positive effects of FB SBT on most of their outcome measures. However, risk of bias was moderate or high in eight studies, and only six studies were of high quality (modified Medical Education Research Study Quality Instrument score ≥ 12.5). Moreover, instructional features and outcome measures varied highly across studies, and only four studies evaluated intervention effects on behavioral outcome measures in the patient setting. Simulation training programs in studies with the highest methodologic quality and most relevant outcome measures all included curriculum integration and range in task difficulty.InterpretationAlthough most studies reported positive effects of simulation training programs on their outcome measures, definitive conclusions regarding training effectiveness on actual bronchoscopy performance in patients could not be made because of heterogeneity of training features and the sparse evidence of training effectiveness on validated behavioral outcome measures in a patient setting.Trial RegistrationPROSPERO; No.: CRD42021262853; URL: https://www.crd.york.ac.uk/prospero/ The implementation of simulation-based training (SBT) to teach flexible bronchoscopy (FB) skills to novice trainees has increased during the last decade. However, it is unknown whether SBT is effective to teach FB to novices and which instructional features contribute to training effectiveness. How effective is FB SBT and which instructional features contribute to training effectiveness? We searched Embase, PubMed, Scopus, and Web of Science for articles on FB SBT for novice trainees until November 10, 2022. We assessed methodologic quality of included studies using a modified version of the Medical Education Research Study Quality Instrument, evaluated risk of bias with relevant tools depending on study design, assessed instructional features, and intended to correlate instructional features to outcome measures. We identified 14 studies from an initial pool of 544 studies. Eleven studies reported positive effects of FB SBT on most of their outcome measures. However, risk of bias was moderate or high in eight studies, and only six studies were of high quality (modified Medical Education Research Study Quality Instrument score ≥ 12.5). Moreover, instructional features and outcome measures varied highly across studies, and only four studies evaluated intervention effects on behavioral outcome measures in the patient setting. Simulation training programs in studies with the highest methodologic quality and most relevant outcome measures all included curriculum integration and range in task difficulty. Although most studies reported positive effects of simulation training programs on their outcome measures, definitive conclusions regarding training effectiveness on actual bronchoscopy performance in patients could not be made because of heterogeneity of training features and the sparse evidence of training effectiveness on validated behavioral outcome measures in a patient setting. PROSPERO; No.: CRD42021262853; URL: https://www.crd.york.ac.uk/prospero/ Take-home PointsStudy Question: How effective is flexible bronchoscopy simulation-based training and which instructional features contribute to training effectiveness?Results: This systematic review shows that flexible bronchoscopy simulation-based training is effective in improving skills when evaluated in a simulation setting. However, the effects of simulation training on skill performance of novices in a patient setting are less clear because of a lack of studies using homogeneous validated outcome measures. Integrating bronchoscopy simulation training programs in the curriculum and increasing task difficulty appear to contribute to training effectiveness.Interpretation: To further improve our knowledge of the effectiveness of bronchoscopy simulation-based training and how to optimize these training programs, we advocate that future studies use more homogeneous validated outcome measures, preferably in a patient setting. Study Question: How effective is flexible bronchoscopy simulation-based training and which instructional features contribute to training effectiveness? Results: This systematic review shows that flexible bronchoscopy simulation-based training is effective in improving skills when evaluated in a simulation setting. However, the effects of simulation training on skill performance of novices in a patient setting are less clear because of a lack of studies using homogeneous validated outcome measures. Integrating bronchoscopy simulation training programs in the curriculum and increasing task difficulty appear to contribute to training effectiveness. Interpretation: To further improve our knowledge of the effectiveness of bronchoscopy simulation-based training and how to optimize these training programs, we advocate that future studies use more homogeneous validated outcome measures, preferably in a patient setting. Use of simulation in health professions education has increased significantly over the past two decades.1Ryall T. Judd B.K. Gordon C.J. Simulation-based assessments in health professional education: a systematic review.J Multidiscip Healthc. 2016; 9: 69-82PubMed Google Scholar This shift from the traditional apprenticeship model (see one, do one, teach one) toward simulation-based training (SBT) is largely caused by the result of concerns for patient safety.2Kennedy C.C. Maldonado F. Cook D.A. Simulation-based bronchoscopy training systematic review and meta-analysis.Chest. 2013; 144: 183-192Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar,3Vozenilek J. Huff J.S. Reznek M. Gordon J.A. See one, do one, teach one: advanced technology in medical education.Acad Emerg Med. 2004; 11: 1149-1154Crossref PubMed Google Scholar In general, the apprenticeship method, and more specifically, flexible bronchoscopy (FB) training, are associated with a higher complication risk4Ouellette D.R. The safety of bronchoscopy in a pulmonary fellowship program.Chest. 2006; 130: 1185-1190Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar,5Stather D.R. MacEachern P. Chee A. Dumoulin E. Tremblay A. Trainee impact on procedural complications: an analysis of 967 consecutive flexible bronchoscopy procedures in an interventional pulmonology practice.Respiration. 2013; 85: 422-428Crossref PubMed Scopus (35) Google Scholar and increased patient discomfort.6Colt H.G. Crawford S.W. Galbraith O. Virtual reality bronchoscopy simulation: a revolution in procedural training.Chest. 2001; 120: 1333-1339Abstract Full Text Full Text PDF PubMed Scopus (214) Google Scholar Hence, a shift to SBT might be desirable. Currently, a variety of FB simulators are used for bronchoscopy training (eg, animal models,7Garner J.L. Garner S.D. Hardie R.J. et al.Evaluation of a re-useable bronchoscopy biosimulator with ventilated lungs.ERJ Open Res. 2019; 5Crossref PubMed Scopus (3) Google Scholar three-dimensional printed airway models,8Byrne T. Yong S.A. Steinfort D.P. Development and assessment of a low-cost 3D-printed airway model for bronchoscopy simulation training.J Bronchology Interv Pulmonol. 2016; 23: 251-254Crossref PubMed Scopus (24) Google Scholar high-fidelity virtual reality simulators9Veaudor M. Gérinière L. Souquet P.J. et al.High-fidelity simulation self-training enables novice bronchoscopists to acquire basic bronchoscopy skills comparable to their moderately and highly experienced counterparts.BMC Med PubMed Scopus Google P. O. is a bronchoscopy simulation PubMed Scopus Google To four on bronchoscopy training programs using simulators C.C. Maldonado F. Cook D.A. Simulation-based bronchoscopy training systematic review and meta-analysis.Chest. 2013; 144: 183-192Abstract Full Text Full Text PDF PubMed Scopus (0) Google L. Simulation-based training in flexible bronchoscopy and a systematic PubMed Scopus Google L. Simulation in and future Med PubMed Scopus Google simulation training in the Scholar The systematic review by et C.C. Maldonado F. Cook D.A. 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