Nha Voduc1, Rosemary Adamson2, Alia Kashgari3, Mark Fenton4, Nancy Porhownick5, Margaret Wojnar6, Krishna Sharma7, Ashley-Mae Gillson8, Carol Chung8, Meghan McConnell9. 1. Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, Canada. Electronic address: nvoduc@toh.ca. 2. Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA; Veterans Affairs Puget Sound Healthcare System, Seattle, WA. 3. Division of Respirology, Department of Medicine, Western University, London, Canada. 4. Division of Respirology, Critical Care and Sleep Medicine, Department of Medicine, University of Saskatchewan, Saskatoon, Canada; Respiratory Research Center, University of Saskatchewan, Saskatoon, Canada. 5. Division of Respirology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada. 6. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Penn State College of Medicine, Pennsylvania, PA. 7. Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, Canada. 8. Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Canada. 9. Department of Innovation in Medical Education, University of Ottawa, Ottawa, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Canada.
Abstract
BACKGROUND: There are currently no reference standards for the development of competence in bronchoscopy. RESEARCH QUESTION: The aims of this study were to (1) develop learning curves for bronchoscopy skill development and (2) estimate the number of bronchoscopies required to achieve competence. STUDY DESIGN AND METHODS: Trainees from seven North American academic centers were enrolled at the beginning of their pulmonology training. Performance during clinical bronchoscopies was assessed by supervising physicians using the Ontario Bronchoscopy Assessment Tool (OBAT). Group-level learning curves were modeled using a quantile regression growth model, where the dependent variable was the mean OBAT score and the independent variable was the number of bronchoscopies performed at the time the OBAT was completed. RESULTS: A total of 591 OBAT assessments were collected from 31 trainees. The estimated regression quantiles illustrate significantly different learning curves based on trainees' performance percentiles. When competence was defined as the mean OBAT score for all bronchoscopies rated as being completed without need for supervision, the mean OBAT score associated with competence was 4.54 (95% CI, 4.47-4.58). Using this metric, the number of bronchoscopies required to achieve this score varied from seven to 10 for the 90th percentile of trainees and from 109 to 126 for the lowest 10th percentile of trainees. When competence was defined as the mean OBAT score for the first independent bronchoscopy, the mean was 4.40 (95% CI, 4.20-4.60). On the basis of this metric, the number of bronchoscopies required varied from one to 11 for the 90th percentile of trainees and from 83 to 129 for the lowest 10th percentile of trainees. INTERPRETATION: We were able to generate learning curves for bronchoscopy across a range of trainees and centers. Furthermore, we established the average number of bronchoscopies required for the attainment of competence. This information can be used for purposes of curriculum planning and allows a trainee's progress to be compared with an established norm.
BACKGROUND: There are currently no reference standards for the development of competence in bronchoscopy. RESEARCH QUESTION: The aims of this study were to (1) develop learning curves for bronchoscopy skill development and (2) estimate the number of bronchoscopies required to achieve competence. STUDY DESIGN AND METHODS: Trainees from seven North American academic centers were enrolled at the beginning of their pulmonology training. Performance during clinical bronchoscopies was assessed by supervising physicians using the Ontario Bronchoscopy Assessment Tool (OBAT). Group-level learning curves were modeled using a quantile regression growth model, where the dependent variable was the mean OBAT score and the independent variable was the number of bronchoscopies performed at the time the OBAT was completed. RESULTS: A total of 591 OBAT assessments were collected from 31 trainees. The estimated regression quantiles illustrate significantly different learning curves based on trainees' performance percentiles. When competence was defined as the mean OBAT score for all bronchoscopies rated as being completed without need for supervision, the mean OBAT score associated with competence was 4.54 (95% CI, 4.47-4.58). Using this metric, the number of bronchoscopies required to achieve this score varied from seven to 10 for the 90th percentile of trainees and from 109 to 126 for the lowest 10th percentile of trainees. When competence was defined as the mean OBAT score for the first independent bronchoscopy, the mean was 4.40 (95% CI, 4.20-4.60). On the basis of this metric, the number of bronchoscopies required varied from one to 11 for the 90th percentile of trainees and from 83 to 129 for the lowest 10th percentile of trainees. INTERPRETATION: We were able to generate learning curves for bronchoscopy across a range of trainees and centers. Furthermore, we established the average number of bronchoscopies required for the attainment of competence. This information can be used for purposes of curriculum planning and allows a trainee's progress to be compared with an established norm.
Authors: Anna K Brady; Wade Brown; Joshua L Denson; Gretchen Winter; Abesh Niroula; Lekshmi Santhosh; W Graham Carlos Journal: ATS Sch Date: 2020-10-21
Authors: Hans J Lee; A Christine Argento; Hitesh Batra; Sadia Benzaquen; Kyle Bramley; David Chambers; Neeraj Desai; H Erhan Dincer; J Scott Ferguson; Satish Kalanjeri; Carla Lamb; Nikhil Meena; Chakravarthy Reddy; Alberto Revelo; Ashutosh Sachdeva; Benjamin Seides; Harsh Shah; Samira Shojaee; David Sonetti; Jeffrey Thiboutot; Jennifer Toth; Keriann Van Nostrand; Jason A Akulian Journal: ATS Sch Date: 2022-06-30
Authors: Wade Brown; Lekshmi Santhosh; Anna K Brady; Joshua L Denson; Abesh Niroula; Meredith E Pugh; Wesley H Self; Aaron M Joffe; P O'Neal Maynord; W Graham Carlos Journal: Crit Care Date: 2020-10-22 Impact factor: 9.097