Using structured progress to measure competence in flexible bronchoscopy

Cold, Kristoffer Mazanti; Svendsen, Morten Bo Søndergaard; Bødtger, Uffe; Nayahangan, Leizl Joy; Clementsen, Paul Frost; Konge, Lars

doi:10.21037/jtd-20-2181

Cited by 10 publications

(6 citation statements)

References 36 publications

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“…Both the intervention group and the control group had a high structured progress score and diagnostic completeness. In an earlier study by Cold et al [14], examining the structured progress score, the mean score for novices with no prior training was 5, while the mean scores were 12 for the control group and 16 for the intervention group in our study. However, the procedure time varied from person to person, and only three participants got a max structured progress score, pointing toward bronchoscopy being challenging to get perfect.…”

Section: Bronchoscopy Performancecontrasting

confidence: 48%

“…The outcomes were the quality of bronchoscopy based on two previously validated and reliable assessment tools for assessing technical skills [14,15] and cognitive load measures [16][17][18]. The primary-outcome measures were a score based on the structured progress score; the systematic visualization and structured passage through the bronchial tree measured in points from 0 to 18 [14], and procedure time from passing the vocal cords to retraction of the endoscope in seconds.…”

Section: Outcome Measuresmentioning

confidence: 99%

“…It was based on the assumption that the intervention group would be faster than the control group, where a minimum of 33% reduction in procedure time was deemed relevant. The control group was expected to complete the procedure in 372 s, and the intervention group was expected to complete the procedure in 280 s. The standard deviation (SD) was 80 s in both groups [14]. Using a twosided significance level of 0.05 with alpha set at 5% and a power of 90%, a sample size of a minimum of 17 participants in each group was required.…”

Section: Sample Size Estimationmentioning

confidence: 99%

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Preparing for Reality: A Randomized Trial on Immersive Virtual Reality for Bronchoscopy Training

et al. 2023

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Background: Bronchoscopy is an essential procedure in the diagnosis and treatment of pulmonary diseases. However, the literature suggests that distractions affect the quality of bronchoscopy and affect inexperienced doctors more than experienced. Objectives: The objective of the study was as follows: does simulation-based bronchoscopy training with immersive virtual reality (iVR) improve the doctors’ ability to handle distractions and thereby increase the quality, measured in procedure time, structured progression score, diagnostic completeness (%), and hand motor movements of a diagnostic bronchoscopy in a simulated scenario. Exploratory outcomes were heart rate variability and a cognitive load questionnaire (Surg-TLX). Methods: Participants were randomized. The intervention group practiced in an iVR environment with a head-mounted display (HMD) while using the bronchoscopy simulator, while the control group trained without the HMD. Both groups were tested in the iVR environment using a scenario with distractions. Results: 34 participants completed the trial. The intervention group scored significantly higher in diagnostic completeness (100 i.q.r. 100–100 vs. 94 i.q.r. 89–100, p value = 0.03) and structured progress (16 i.q.r. 15–18 vs. 12 i.q.r. 11–15, p value 0.03) but not in procedure time (367 s standard deviation [SD] 149 vs. 445 s SD 219, p value = 0.06) or hand motor movements (−1.02 i.q.r. −1.03–[−1.02] versus −0.98 i.q.r. −1.02–[–0.98], p value = 0.27). The control group had a tendency toward a lower heart rate variability (5.76 i.q.r. 3.77–9.06 vs. 4.12 i.q.r. 2.68–6.27, p = 0.25). There was no significant difference in total Surg-TLX points between the two groups. Conclusion: iVR simulation training increases the quality of diagnostic bronchoscopy in a simulated scenario with distractions compared with conventional simulation-based training.

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Section: Bronchoscopy Performancecontrasting

confidence: 48%

Section: Outcome Measuresmentioning

confidence: 99%

Section: Sample Size Estimationmentioning

confidence: 99%

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Preparing for Reality: A Randomized Trial on Immersive Virtual Reality for Bronchoscopy Training

et al. 2023

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“…This study focuses on reaching a specific level of competency in EGD using mastery learning. The same approach was used to develop and assess competency in other endoscopy procedures, such as bronchoscopy and colonoscopy 35 36 . Our test assesses EGD competency exclusively in contrast to the SAGES (Society of American Gastrointestinal and Endoscopic Surgeons) Fundamentals of Endoscopic Surgery (FES) exam, which assesses gastrointestinal endoscopic skills including both EGD and colonoscopy 37 .…”

Section: Discussionmentioning

confidence: 99%

Assessment of esophagogastroduodenoscopy skills on simulators before real-life performance

et al. 2022

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Background Operator competencies are essential for esophagogastroduodenoscopy (EGD) quality making appropriate training with a final test important. The aims were to develop a test for assessing skills in performing EGD, gather validity evidence for the test, and establish a credible pass/fail score. Method An expert panel developed a practical test at the Simbionix GI-mentor II simulator (3D Systems) and an EGD phantom (OGI 4, CLA Medical) with a diagnostic (DP) and a technical skills part (TSP) for a prospective validation study. During the test a supervisor measured 1) total time, 2) degree of mucosal visualization, and 3) landmarks and pathology identification. The Contrasting Groups’ standard setting method was used to establish a pass/fail score. Results We included 15 novices (N), 10 intermediates (I), and 10 experienced endoscopists (E). The internal structure was high with a Cronbach’s alpha of 0.76 for TSP time consumption and 0.74 for the identification of landmarks. Mean total times for the DP were [minutes] N: 15.7, I: 11.3, E: 7.0 and the TSP N: 7.9, I: 8.9, E: 2.9. The total numbers of identified landmarks were N: 26, I: 41, E: 48. Mean visualization percentages were N: 80, I: 71, E: 71. A pass/fail standard was established requiring the identification of all landmarks and performance of the TSP in less than 5 minutes. All experienced endoscopists passed, while no other did. Conclusion We established a test that can distinguish between participants with different competencies. This enables an objective and evidence-based approach for assessing competencies in EGD.

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“…[ 16 ] For bronchoscopy, a systematic approach is also correlated with inspection of more segments and a lower procedure time. [ 17 ] Therefore, we recommend using a stepwise and systematic approach when learning and performing the procedure. First, the trainee should learn to recognize the six anatomical landmarks in the following order by observing the procedure performed by an experienced colleague.…”

Section: Systematic and Stepwise Approachmentioning

confidence: 99%