Comparative Effectiveness of Low- and High-Fidelity Bronchoscopy Simulation for Training in Conventional Transbronchial Needle Aspiration and User Preferences

Background: Conventional transbronchial needle aspiration (TBNA) can be learned using high-fidelity virtual-reality platforms and low-fidelity models comprised of molded silicone or excised animal airways. Objectives: The purpose of this study was to determine perceptions and preferences of learners and instructors regarding the comparative effectiveness of low-fidelity and high-fidelity bronchoscopy simulation for training in TBNA. Methods: During the 2008 annual CHEST conference, a prospective randomized crossover design was used to train study participants in three methods of conventional TBNA using lowand high-fidelity models. Likert style questions were administered to learners and instructors in order to elicit preferences and opinions regarding educational effectiveness of the models. Results were tabulated and depicted in graphic format, with medians calculated. Results: Learners felt that the models were equally enjoyable (13–13) and enthusiasm generating (low 17-high 15). There was preference for low-fidelity in terms of realism Received: December 7, 2009 Accepted after revision: March 23, 2010 Published online: July 9, 2010 Henri Colt, MD, FCCP UCI Medical Center 101 the City Drive South, The City Tower, Suite 400, Zot 4095 Orange, CA 92868-3217 (USA) Tel. +1 714 456 5150, Fax +1 714 456 2764, E-Mail hcolt @ uci.edu © 2010 S. Karger AG, Basel 0025–7931/10/0804–0327$26.00/0 Accessible online at: www.karger.com/res The CHEST Simulation Center exempted this study from IRB review. D ow nl oa de d by : 54 .7 0. 40 .1 1 11 /2 3/ 20 17 2 :4 3: 41 A M Davoudi /Wahidi /Zamanian Rohani /Colt Respiration 2010;80:327–334 328 els to teach TBNA include expensive high-fidelity platforms using three-dimensional virtual anatomy and force feedback technology [1] or low-fidelity models comprised of molded silicone or excised animal airways [2] . Simulated environments create opportunities where tasks can be practiced repeatedly with minimal interference, risks to patients are eliminated, and training scenarios can be tailored to individual learners’ needs [3–5] . Both lowand high-fidelity simulation have been shown to enhance physician competence in procedural skills [4– 7] , including bronchoscopy [8] , while saving time and improving the learning curve [9–10] . Skills thus acquired transfer effectively to the patients’ bedside [11–14] , and physicians who are trained using simulators perform significantly better than controls in their clinical encounters [15–17] . Simulator training with objective assessment and feedback identifies and reduces errors, and provides opportunities for remedial intervention [18–21] . In addition, the use of simulator platforms and inanimate models to train novices prior to patient contact has been proven to promote patient comfort and safety [17, 22] . While in many procedural fields investigators have explored the comparative educational efficacy, usability and user satisfaction of lowand high-fidelity simulation [23–30] , a comparative study of the educational effectiveness of lowand high-fidelity models in the realm of minimally invasive bronchoscopic procedures has not been reported. The purpose of this study, therefore, was to determine the perceptions and preferences of learners and instructors regarding the comparative effectiveness of lowand high-fidelity bronchoscopy simulation for training in conventional TBNA. This study was designed to test the hypothesis that despite greater enthusiasm among instructors and learners for a high-cost, virtual-reality high-fidelity simulator, as compared to an affordable, low-fidelity airway model, the actual perceptions of either group would not be different regarding realism, ease of use, ability to learn patient and equipment safety measures, and ability to learn the technical skills necessary for performing three different methods of conventional TBNA.