A Randomized Trial of Teaching Endobronchial Ultrasound: Wet Lab Versus Computer Simulatio

Abstract

PURPOSE: Bronchoscopy simulation is an effective learning tool for basic and advanced bronchoscopy procedures including endobronchial ultrasound guided transbronchial needle aspiration (EBUS). Wet lab simulation and computer based simulation models have been used to teach EBUS. This study was designed to compare these two modalities with regards to skill acquisition and learner preference. METHODS: A prospective, randomized study of pulmonologists, thoracic surgeons and pulmonary trainees learning EBUS at a 2 day EBUS continuing medical education course. All subjects received EBUS education via a series of lectures and live case demonstrations. They were then randomized to EBUS simulation training by wet lab (n=6) or computer based simulation (n=6). Subjects were asked to complete a questionnaire evaluating their learning experience and preferences, followed by a test of EBUS performance via a standardized simulated case on the computer simulator, previously validated to correlate with clinical skill. RESULTS: The computer simulator group performed significantly better on the standardized EBUS case than the wet lab group in the percentage of lymph nodes correctly identified [70.4% (+/-16.7) versus 42.9% (+/-19.9), p=0.027]. Procedure time in minutes [25.3 (+/-6.1) versus 25.2 (+/-2.5), p=0.984] and percentage of successful biopsies [81.3% (+/-14.9) versus 74.0% (+/-17.3), p=0.453] were not statistically different between the 2 groups. All subjects in both groups (6/6 in both groups) were very confident or confident that they could successfully perform needle aspiration of an enlarged (>1.5cm) mediastinal lymph node, however, only 2/6 subjects from each group stated that they would be confident performing a staging EBUS procedure with needle aspiration of small (0.5-1.0cm) mediastinal lymph nodes. All subjects felt that wet lab and computer EBUS simulation offer important complementary learning opportunities. CONCLUSIONS: Using an EBUS simulator leads to improved ability to correctly identify lymph nodes as compared to wet lab simulation (which does not replicate human airway and mediastinal anatomy) but actual biopsy performance is similar. Computer simulators and wet lab simulation appear to be complementary techniques in the learning of EBUS. CLINICAL IMPLICATIONS: Computer EBUS simulation and wet lab simulation are effective methods of learning basic EBUS skills that appear to be complementary.