Advances in Bronchoscopic Simulation Training

Abstract

Flexible bronchoscopy is an essential skill for clinicians amongst several disciplines including critical care, respiratory medicine and thoracic surgery. Traditionally this skill has been taught using the apprenticeship model which has recognised limitations with regards to patient safety, procedural volume and variability amongst training. Simulation based bronchoscopy training allows for learning in a safe, low stress environment with zero patient harm and provides an opportunity for deliberate repeated practice. Simulation based training has gained increasing acceptance with high quality evidence demonstrating accelerated bronchoscopy skill acquisition, improvements in muscle memory and hand-eye coordination with greater trainee satisfaction. Studies have also supported the transfer of skills from simulation training to clinical practice. Simulation training can be delivered using high fidelity simulators or low fidelity simulation, the latter most commonly involving inanimate models. Low fidelity models lack realism, adaptation and application for specific pathologies, though data demonstrates greater success at bronchoscopy assisted intubation when compared with traditional approaches to training. High fidelity simulators including virtual reality bronchoscopy simulators provide a highly realistic environment with the added advantage of integrated feedback features and assessment through quantitative measurements of objective data. Simulation allows for both standardisation of bronchoscopic training and of assessment of competency using tools such as the Endobronchial Ultrasound-guided Transbronchial Needle Aspiration questionnaire and Bronchoscopy Skills and Tasks Assessment tool. Despite the numerous benefits of simulation based training adoption has been slow and inconsistent, which may be attributed to trainer preferences for traditional training methods, the costs involved with simulation equipment and the time required to introduce simulation based training programmes.