title: Learning experience of linear endobronchial ultrasound among pulmonary trainees.
abstract: BACKGROUND
  Linear endobronchial ultrasound (EBUS) allows real-time guidance of transbronchial needle aspiration of thoracic structures and has become an increasingly important diagnostic tool for chest physicians. Little has been published about the learning experience of operators with this technology. The purpose of this study was to define the learning experience of EBUS-guided transbronchial needle aspiration (EBUS-TBNA) among pulmonary trainees.
  
  
  METHODS
  This was a multicenter cohort study of fellows in pulmonary medicine over the first 2 years of their training. Prior to performing EBUS-TBNA, all participants had to complete 30 conventional bronchoscopies, an EBUS-specific didactic curriculum, and a simulation session with a plastic airway model. Each consecutive EBUS procedure was scored with a checklist that evaluated the ability to pass a bronchoscope through vocal cords, identify the appropriate node for sampling, acquire adequate ultrasound images, guide the bronchoscopy team through the technical steps of EBUS-TBNA, and obtain adequate tissue samples.
  
  
  RESULTS
  Thirteen pulmonary trainees from three training programs were enrolled in the study and were observed over a 2-year period. The majority of trainees were able to perform all essential steps of EBUS-TBNA and obtain adequate tissue after performing an average of 13 (95% CI, 7-16) procedures.
  
  
  CONCLUSIONS
  Pulmonary trainees needed an average of 13 procedures to achieve first independent successful performance of EBUS-TBNA following a training protocol that included a didactic curriculum and simulation-based practice. Our findings could guide pulmonary fellowship directors in planning EBUS training and establishing a reasonable juncture to assess EBUS skills with validated assessment tools.
authors.affiliation: Division of Pulmonary and Critical Care Medicine and Department of Medicine, Duke University Medical Center, Durham, NC. Electronic address: momen.wahidi@duke.edu.
authors.forename: Momen M
authors.initials: MM
authors.lastname: Wahidi
authors.affiliation: University of North Carolina, Chapel Hill, NC.
authors.forename: Cidney
authors.initials: C
authors.lastname: Hulett
authors.affiliation: Medical University of South Carolina, Charleston, SC.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Pastis
authors.affiliation: Virginia Commonwealth University Medical Center, Richmond, VA.
authors.forename: R Wesley
authors.initials: RW
authors.lastname: Shepherd
authors.affiliation: Division of Pulmonary and Critical Care Medicine and Department of Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Shofer
authors.affiliation: Division of Pulmonary and Critical Care Medicine and Department of Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Kamran
authors.initials: K
authors.lastname: Mahmood
authors.affiliation: Virginia Commonwealth University Medical Center, Richmond, VA.
authors.forename: Hans
authors.initials: H
authors.lastname: Lee
authors.affiliation: Virginia Commonwealth University Medical Center, Richmond, VA.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Malhotra
authors.affiliation: Division of Pulmonary and Critical Care Medicine and Department of Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Barry
authors.initials: B
authors.lastname: Moser
authors.affiliation: Medical University of South Carolina, Charleston, SC.
authors.forename: Gerard A
authors.initials: GA
authors.lastname: Silvestri
mesh_terms: D000328:Adult; D001707:Biopsy, Needle / Q000379:methods*; D001999:Bronchoscopy / Q000193:education*; D002983:Clinical Competence; D004502:Education, Medical, Continuing / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D059032:Learning Curve; D008171:Lung Diseases / Q000175:diagnosis*; D008297:Male; D015272:Pulmonary Medicine / Q000193:education*; D015203:Reproducibility of Results; D014481:United States