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Respiratory education and training issues
P93 A simulated bronchoscopy course for new specialist trainees
  1. S Mandal1,
  2. A R C Patel2,
  3. J J P Goldring2
  1. 1Department of Respiratory Medicine, Colchester University Hospital, Essex, UK
  2. 2Academic Unit of Respiratory Medicine, UCL Medical School, London, UK

Abstract

Introduction and objectives New trainees typically perform initial bronchoscopies on real patients under supervision. This model of training has safety and comfort implications relying on timely acquisition of skills, potentially compromised by a reduction in the number of bronchoscopies performed by trainees. Simulators have been validated in training novice practitioners. We present a model for initial bronchoscopy training by registrars for registrars.

We developed a course based on survey data from North-East Thames trainees. We provided first year trainees with precourse material consisting of BTS guidelines and a presentation of bronchial anatomy. The day involved 1 h of theory, including indications, contra-indications, sedation, local anaesthesia, consent and management of complications. This was followed by a practical session with specialist nurses including assembling a bronchoscopy stack, troubleshooting and effective team-working. Most of the day was divided into three stations:

  1. Use of two simulators (Accutouch, Immersion Corporation, USA), each trainee had 45 min of 1:1 tuition. Trainees were objectively scored using the validated Bronchoscopy Skills and Tasks Assessment Tool (Bronchoscopy International, USA). This score and freetext comments were sent to the trainees to discuss with consultants.

  2. A slideshow of airway anatomy and pathology followed by MCQs addressing pre-course material.

  3. Hands-on flexible bronchoscopy through a static bronchial tree model.

Feedback was assessed using a questionnaire at the end of the day.

Results 9/11 trainees were within 3 months of starting StR training, 2/11 were within 12 months, having performed a median of five bronchoscopies (interquartile range 5–30). All trainees felt the course was pitched at the right level. They would all recommend this course to others, giving a rating of 4.8/5. 90% thought the course should be carried out within the first 3 months of training. All participants would change their practice as a result of what had been learnt on the course. Suggestions for improvement included grey cases and even more hands-on simulation time.

This potential model for bronchoscopy training was:

  • Pitched at the right level.

  • Delivered at an appropriate time.

  • Received overwhelmingly positive feedback.

  • Can be effectively delivered by experienced peers.

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