Simulation-based bronchoscopy training.

We read with great interest an article by Kennedy and colleagues 1 in a recent issue of CHEST (July 2013) in which a systematic review and meta-analysis of stud ies revealed signifi cant improvements in skills and behaviors when comparing simulation-based bronchoscopy with no intervention. However, the article also identifi ed gaps in evidence, such as the lack of clear understanding of optimal design or choice of modalities in relation to simulationbased bronchoscopy train ing. Based on our experience of setting up a regional simulation bronchoscopy program, we are able to address these issues. We established fi ve clinical skills laboratories that deliver simulation bronchoscopy training. We also set up a group of regional experienced bronchoscopists responsible for the development of simulation bronchoscopy training. We have run 15 courses and trained . 60 candidates. Although initially we used different formats for the courses, the trainees’ overall experience of simulationbased bronchoscopy was extremely positive. Based on our initial experience, we established that the optimal design for delivering simulation-based bronchoscopy courses should incorporate a blend of short lectures, e-learning, and hands-on experience using simulation. To be successful, simulation-based bronchoscopy requires a high trainer-to-trainee ratio (ideally 1:2), and, therefore, we established a faculty of experienced bronchoscopists with a special inter est in procedural training. Our results confi rmed signifi cant improvement, for both novices and more experienced trainees, in the technical ability of handling bronchoscopes, their understanding of anatomy and identifi cation of bronchial segments, and their knowledge of the procedure; the improvements were in the range of 20% and 30% when using high fi delity alone and in combination with low-fi delity bronchoscopy simulation, respectively. 2