title: Trainee impact on procedural complications: an analysis of 967 consecutive flexible bronchoscopy procedures in an interventional pulmonology practice.
abstract: BACKGROUND
  Increased complications have been demonstrated in patients undergoing some medical procedures performed by trainees. Flexible bronchoscopy is generally considered a safe procedure; however, complications can include pneumothorax, bleeding and even death.
  
  
  OBJECTIVE
  This study aimed to determine the impact of trainees during interventional pulmonology procedures on procedure time, sedation use and complications.
  
  
  METHODS
  A retrospective review of a quality improvement database from all consecutive medical procedures performed by an interventional pulmonologist (D.R.S.) at the University of Calgary, from July 1, 2007, to April 1, 2011.
  
  
  RESULTS
  Of 1,100 consecutive procedures during the study period, 967 were flexible bronchoscopies. A trainee participated in 82.2% of the procedures. Complications occurred in 38 patients (3.9%). No death occurred. Significant differences were seen when a trainee participated in the procedure versus when no trainee participated for procedure length [50.81 vs. 32.49 min, difference 18.32 min (95% CI 16.04-20.60), p = 0.001], dose of midazolam used [6.34 vs. 5.73 mg, difference 0.61 mg (95% CI 0.15-1.08), p = 0.01], dose of propofol used [153.08 vs. 111.60 mg, difference 41.48 mg (95% CI 21.81-61.15), p = 0.001], as well as the number of complications [4.5 vs. 1.2%, difference 3.3%, p = 0.048].
  
  
  CONCLUSIONS
  In an academic interventional pulmonology practice utilizing the apprenticeship model for procedural education, trainee participation in procedures can increase procedure time and the amount of sedation required, and result in increased complications. Medical procedural training methods that do not involve practicing on patients warrant further investigation in order to reduce the burden of procedural learning for patients.
authors.affiliation: Division of Respiratory Medicine, Department of Medicine, University of Calgary, Calgary, Alta., Canada. davestather @ yahoo.ca
authors.forename: David R
authors.initials: DR
authors.lastname: Stather
authors.forename: Paul
authors.initials: P
authors.lastname: MacEachern
authors.forename: Alex
authors.initials: A
authors.lastname: Chee
authors.forename: Elaine
authors.initials: E
authors.lastname: Dumoulin
authors.forename: Alain
authors.initials: A
authors.lastname: Tremblay
mesh_terms: D000368:Aged; D001999:Bronchoscopy / Q000009:adverse effects / Q000193:education / Q000379:methods; D002170:Canada; D002983:Clinical Competence; D016292:Procedural Sedation / Q000379:methods; D004522:Educational Status; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000145:classification / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D017145:Models, Educational; D061646:Operative Time; D015272:Pulmonary Medicine / Q000193:education; D058996:Quality Improvement; D012140:Respiratory Tract Diseases / Q000175:diagnosis / Q000628:therapy; D012189:Retrospective Studies; D013663:Teaching / Q000379:methods / Q000592:standards