title: Endobronchial ultrasound learning curve in interventional pulmonary fellows.
abstract: OBJECTIVE
  Little published data exist regarding the learning curve for endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA). We sought to assess the improvement in skill as trainees learned EBUS-TBNA in a clinical setting.
  
  
  METHODS
  This is a multicentre cohort study of EBUS-TBNA technical skill of interventional pulmonology (IP) fellows as assessed with EBUS-TBNA computer simulator testing every 25 clinical cases throughout IP fellowship training.
  
  
  RESULTS
  Nine fellows from three academic centres in the United States and Canada were enrolled in the study. Ongoing improvements were seen for EBUS-TBNA efficiency score and percentage of lymph nodes correctly identified on ultrasound exam, even after 200 clinical cases. Expert-level technical skill was obtained for EBUS efficiency score and for percentage of lymph nodes correctly identified on ultrasound exam at a median of 212 and 164 procedures, respectively; however, 33% of fellows did not achieve expert-level technical skill for either metric during their fellowship training. Significant variation in learning curves of the fellows was observed.
  
  
  CONCLUSIONS
  Significant variation is seen in the EBUS-TBNA learning curves of individual IP fellows and for individual procedure components, with ongoing improvement in EBUS-TBNA skill even after 200 clinical cases. These results highlight the need for validated, objective measures of individual competence, and can assist training programmes in ensuring adequate procedure volumes required for a majority of trainees to successfully complete these assessments.
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: David R
authors.initials: DR
authors.lastname: Stather
authors.forename: Alex
authors.initials: A
authors.lastname: Chee
authors.forename: Paul
authors.initials: P
authors.lastname: MacEachern
authors.forename: Elaine
authors.initials: E
authors.lastname: Dumoulin
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Hergott
authors.forename: Jacob
authors.initials: J
authors.lastname: Gelberg
authors.forename: Eric
authors.initials: E
authors.lastname: Folch
authors.forename: Adnan
authors.initials: A
authors.lastname: Majid
authors.forename: Anne V
authors.initials: AV
authors.lastname: Gonzalez
authors.forename: Alain
authors.initials: A
authors.lastname: Tremblay
mesh_terms: D000328:Adult; D001980:Bronchi; D001999:Bronchoscopy; D002983:Clinical Competence; D015331:Cohort Studies; D003198:Computer Simulation; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D059032:Learning Curve; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D011446:Prospective Studies; D015272:Pulmonary Medicine / Q000193:education*; D014481:United States
keywords: bronchoscopy; education; endobronchial ultrasound; simulation; training