A prospective multicenter study of competency metrics and educational interventions in the learning of bronchoscopy among new pulmonary fellows.
BACKGROUND
Learning medical procedures relies predominantly on the apprenticeship model, and competency is established based on the number of performed procedures. Our study aimed to establish bronchoscopy competency metrics based on performance and enhanced learning with educational interventions.


METHODS
We conducted a prospective study of the acquisition of bronchoscopy skills and cognitive knowledge in two successive cohorts of new pulmonary fellows between July 5, 2006, and June 30, 2008. At prespecified milestones, validated tools were used for testing: the Bronchoscopy Skills and Tasks Assessment Tool (BSTAT), an objective evaluation of bronchoscopy skills with scores ranging from 0 to 24, and written multiple-choice questions examinations. The first cohort received training in bronchoscopy as per the standards set by each institution, whereas the second cohort received educational interventions, including training in simulation bronchoscopy and an online bronchoscopy curriculum.


RESULTS
There was significant variation among study participants in bronchoscopy skills at their 50th bronchoscopy, the minimum number previously set to achieve competency in bronchoscopy. An educational intervention of incorporating simulation bronchoscopy enhanced the speed of acquisition of bronchoscopy skills, as shown by the statistically significant improvement in mean BSTAT scores for seven of the eight milestone bronchoscopies (P < .05). The online curriculum did not improve the performance on the written tests; however, compliance of the learners with the curriculum was low.


CONCLUSIONS
Performance-based competency metrics can be used to evaluate bronchoscopy skills. Educational interventions, such as simulation-based training, accelerated the acquisition of bronchoscopy skills among first-year pulmonary fellows as assessed by a validated objective assessment tool.
Wahidi
Momen M
MM
Division of Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Box 3683, Durham, NC 27710, USA. momen.wahidi@duke.edu
Silvestri
Gerard A
GA
Coakley
Raymond D
RD
Ferguson
J Scott
JS
Shepherd
R Wesley
RW
Moses
Leonard
L
Conforti
John
J
Que
Loretta G
LG
Anstrom
Kevin J
KJ
McGuire
Franklin
F
Colt
Henri
H
Downie
Gordon H
GH
D001999:Bronchoscopy; D002983:Clinical Competence / Q000592:standards*; D015331:Cohort Studies; D004503:Education, Medical, Graduate / Q000379:methods; D006801:Humans; D007396:Internship and Residency; D007858:Learning; D008348:Manikins; D011446:Prospective Studies; D015272:Pulmonary Medicine / Q000193:education* / Q000295:instrumentation; D012189:Retrospective Studies