title: Assessment of competence in simulated flexible bronchoscopy using motion analysis.
abstract: BACKGROUND
  Flexible bronchoscopy should be performed with a correct posture and a straight scope to optimize bronchoscopy performance and at the same time minimize the risk of work-related injuries and endoscope damage.
  
  
  OBJECTIVE
  We aimed to test whether an automatic motion analysis system could be used to explore if there is a correlation in scope movements and the operator's level of experience. Our hypothesis was that experienced bronchoscopists move less and keep the flexible scope straighter than less-experienced bronchoscopists while performing procedures.
  
  
  METHODS
  Eleven novices, 9 intermediates and 9 experienced bronchoscopy operators performed 3 procedures each on a bronchoscopy simulator. The Microsoft Kinect system was used to automatically measure the total deviation of the scope from a perfectly straight, vertical line.
  
  
  RESULTS
  The low-cost motion analysis system could measure the accumulated deviation of the scope precisely during the procedure. The deviations were greatest for the novices and smallest for the most experienced operators for all 3 procedures (p = 0.01, p = 0.01 and p = 0.04, respectively). The total deviation from the straight scope correlated negatively with the performance on the simulator (virtual-reality simulator score; p < 0.001).
  
  
  CONCLUSIONS
  The motion analysis system could discriminate between different levels of experience. Automatic feedback on correct movements during self-directed training on simulators might help new bronchoscopists learn how to handle the bronchoscope like an expert.
authors.affiliation: Department of Pulmonology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
authors.forename: Sara
authors.initials: S
authors.lastname: Colella
authors.forename: Morten Bo
authors.initials: MB
authors.lastname: Søndergaard Svendsen
authors.forename: Lars
authors.initials: L
authors.lastname: Konge
authors.forename: Lars Bo
authors.initials: LB
authors.lastname: Svendsen
authors.forename: Pradeesh
authors.initials: P
authors.lastname: Sivapalan
authors.forename: Paul
authors.initials: P
authors.lastname: Clementsen
mesh_terms: D001999:Bronchoscopy / Q000592:standards* / Q000706:statistics & numerical data; D002983:Clinical Competence / Q000706:statistics & numerical data*; D006801:Humans; D011446:Prospective Studies