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Abstract
Introduction Bronchoscopy, an integral skill for respiratory registrar training, has been challenged by changing work patterns. Exposure to interventional bronchoscopy has posed further challenges to trainees.
Objective To assess if UK respiratory trainee bronchoscopy practice and skills are in keeping with guidelines and whether their curriculum is being adhered to. We also gauged trainee attitudes and exposure to interventional bronchoscopy.
Methods A survey was designed by us to assess training opportunities, exposure, competency and practice in conventional bronchoscopy with a section dedicated to interventional bronchoscopy. This was piloted locally then expanded nationally with 15 deaneries participating.
Results 144 replies represented 24% of potential survey recipients. 13% had bronchoscopy experience outside specialist training such as fellowships or overseas experience.
53% were scheduled to attend bronchoscopy lists at least weekly although 27% achieved this (mainly due to on-call commitments). Just 70% of trainees had performed >200 bronchoscopies by their final training year. 97% kept a logbook, though only 62% recorded ‘hit-rates’.
More scope via nose than mouth (53% vs 14%) and from the front than behind (44% vs 15%). Most right-handed (68%) and left-handed (73%) trainees preferred handling the control-lever with their dominant hand, 58% were influenced by their first trainer. 98% used midazolam and 52% opioids for sedation with 8% routinely using no sedation. Trainees tend use midazolam rather than opioids first when using both (61% vs 24%).
By the final year of training, not everyone was completely independent with common diagnostic procedures, e.g. only 30% were for transbronchial biopsy. Almost all were trained on-the-job (figure). 62% of trainees rated flexible bronchoscopy training excellent or good.
Unfortunately most interventional bronchoscopy techniques weren’t experienced by the vast majority. Only TBNA (36%) and EBUS-TBNA (22%) were performed by significant numbers of trainees. 24% had a definite interest in interventional bronchoscopy and of those 54% rated training poor or very poor.
Discussion The results have highlighted bronchoscopy training deficiencies and a substantial number of trainee’s desire for exposure to interventional bronchoscopy techniques. Using e-portfolio akin to that already used for endoscopy and creating separate training pathways for interventional bronchoscopy may help in remedying this.
