A competency‐based test of bronchoscopic knowledge using the Essential Bronchoscopist: An initial concept study

Abstract

Background and objective Competency-based training and assessment are increasingly replacing the traditional structure- and process-based model of medical education. The web-based Essential Bronchoscopist (EB) is an open access, laddered, competency-based curriculum of question-answer sets pertaining to basic bronchoscopic knowledge, accessible in five languages. The purpose of this study was to use consensus to evaluate whether question-answer sets (items) from the EB could provide material from which to devise competency-based tests of bronchoscopic knowledge that could be used in countries with different health-care environments. Methods Ten junior and five senior bronchoscopists in Argentina and the USA were asked to identify the material in each of the 186 items of the EB as either ‘not necessary’, ‘necessary’ or ‘absolutely necessary’ for inclusion in a competency-based test of bronchoscopic knowledge. The kappa statistic was used to analyse inter-rater agreement. Results More than 80% of the 30 participants rated 150 of 186 items as necessary or absolutely necessary. Seventy items were rated as absolutely necessary by more than 50% of participants and as necessary or absolutely necessary by more than 90%. There was no statistically significant difference between items selected, based on level of training or environment of practice. Conclusion Consensus among junior and senior bronchoscopists from two culturally different health-care environments demonstrated that question-answer sets from the EB can be used to provide material for competency-based tests of bronchoscopic knowledge.

Developments in Simulation Bronchoscopy Training

“…For example, trainees may watch a video of a procedure or use a web-based e-learning module such as that available at British Thoracic Society (www.brit-thoracic.org.uk) or Essential Bronchoscopist (www.bronchoscopy.org) web sites [10][11][12]. Evidence suggests that instructional videotaped, web-based educational material or even simple question and answer exercises can improve visual perception and discrimination skills of the learner, and provide cognitive skills essential for performing the procedure most likely through acquisition of anatomical knowledge, recognition of pathological abnormalities, technical information such as consenting, or knowledge of sedation and use of local anesthesia [4,11,13]. Although there is some evidence contrary to this [12].…”

“…Moreover simulation may standardize assessing bronchoscopy competence, which currently is based on the record of number of procedures performed, subjective educational supervisors report and the outcomes of work-based assessments; the direct observation of procedural skills (DOPS), which grade competency based on multiple stages varying from performing the procedure under close supervision to being independent [11]. Simulation training within the confines of a controlled environment of the skills laboratory provides a safe training environment of practical procedures, enhances professional and learning experience, protects patients' safety by reducing exposure to trainees' deficiencies as well as protecting trainees from deficient training environment.…”

“…The argument for poor quality data is true in the context of low fidelity simulation bronchoscopy as the current evidence is not sufficient to advocate its use beyond the basic skills training [14,29]. In contrast, there is quality evidence from randomized controlled studies for the use of VRS bronchoscopy being recommended; firstly, for acquisition of bronchoscopy skills with the aim to subsequently transfer of the simulation learned skills to the bedside and secondly, as a tool for development and assessment of competency [11,42]. Moreover, there is evidence that bronchoscopy skills acquired through simulation can be successfully transferred to patients' care [12,38].…”

Web-based versus traditional lecture: are they equally effective as a flexible bronchoscopy teaching method?

“…Davoudi et al [9] proposed a test of bronchoscopic knowledge, also based on the Essential Bronchoscopist® website in which bronchoscopists classified the content of the website according to its relevance to clinical practice. More than 80% of survey respondents classified the majority of the website's content as necessary or absolutely necessary, showing that practitioners accept the Web as a potentially important teaching medium.…”

Bronchoscopy simulation: a brief review

“…Additional systematic research is needed in order to explore issues such as the possibility of integration of bronchoscopy simulation in the framework of a bronchoscopy curriculum and assessment measures (Davoudi et al 2006(Davoudi et al , 2007, adaptation of learning strategies to diverse settings and different subspecialty needs, the capture of clinical variation and varying levels of difficulty for a more realistic simulated experience, and methods to individualize the simulated learning experience. The results from large multicenter studies will need to ultimately demonstrate improved educational and patient-care outcomes, and most importantly explore the transfer of skills to the bedside.…”