Learning Electromagnetic Navigational Bronchoscopy and Percutaneous Transthoracic Needle Biopsy (LEAP)

Abstract

Background Prior studies in pulmonology have examined the validity of procedural training tools, however, translation of simulation skill acquisition into real world competency remains understudied. We examine an assessment process with a simulation training course for electromagnetic navigational (EMN) bronchoscopy and percutaneous transthoracic needle aspiration (PTTNA). Methods A cohort study was conducted by subjects using EMN bronchoscopy and PTTNA. A procedural assessment tool was developed to measure basic competency for EMN bronchoscopy and PTTNA at three different time points: first simulation case, final simulation case upon reaching a competent score, and at their first live case. The assessment tool was divided into four domains (total score 4–16, competency ≥ 12) with each domain requiring a passing score (1–4, competency ≥ 3.0). Complication, and procedural time were collected during their first live case. Results Twenty-two serial procedures (12 EMN bronchoscopies, 10 EMN PTTNA) were observed by fourteen subjects. The mean first simulation score for EMN bronchoscopy (4.66 ±0.89) improved after cadaver simulation (12.67 ±0.89, median 3 simulations attempts). The subjects’ mean score for their first live case was 13.0 ±0.85 (self-reported score 12.5 ±1.07). For EMN PTTNA, the mean first simulation score (4.3 ±2.40) improved after cadaver simulation (12.6 ±1.51, median 3 simulation attempts). The subjects’ mean score for their first live PTTNA case was 12.5 ±2.87 (self-reported score 12.1 ±1.05). There was only one minor complication. Conclusion Learning EMN bronchoscopy/PTTNA is feasible using a structured simulation course with an assessment tool.

Safety and diagnostic performance of pulmonologists performing electromagnetic guided percutaneous lung biopsy (SPiNperc)

“…Practitioner training is another important aspect of all procedures. With proper training on how to use the navigational software and equipment, coupled with expert teaching, competency in EM‐guided percutaneous lung biopsy significantly increases . This is demonstrated by our analysis showing that experts, who performed at a single centre with the highest volume of EM‐guided percutaneous lung biopsies, had a higher diagnostic rate and lower complication rate than their counterparts.…”

Virtual or reality: divergence between preprocedural computed tomography scans and lung anatomy during guided bronchoscopy

“…CT, computed tomography. *The SPiN Thoracic Navigation System™ also includes SPiN Perc™, a system of navigated transthoracic needle aspiration (27,(57)(58)(59) which is outside the scope of this review article yet still subject to CT-to-body divergence.…”

Training in interventional pulmonology: the European and US perspective

“…This cycle continues until the learner accomplishes competency then mastery prior to undertaking a more complex skill task. In interventional pulmonology, we lack formative assessment tools to aid in the feedback and setting standards; however, there are ongoing development projects in this field, and recently standards for certain procedures have been developed [36][37][38]. In addition, we need faculty development to optimise pedagogical methods in developing/assessing decision-making, psychomotor skills and medical knowledge.…”