Impact of a Multimodal Simulation-based Curriculum on Endobronchial Ultrasound Skills

Background: Currently there is no consensus on ideal teaching method to train novice trainees in EBUS. Simulation-based procedure training allows direct observation of trainees in a controlled environment without compromising patient safety. Objective: We wanted to develop a comprehensive assessment of endobronchial ultrasound (EBUS) performance of pulmonary fellows and assess the impact of a multimodal simulation-based curriculum for EBUS-guided transbronchial needle aspiration. Methods: Pretest assessment of 11 novice pulmonary fellows was performed using a three-part assessment tool, measuring EBUS-related knowledge, self-confidence, and procedural skills. Knowledge was assessed by 20 multiple-choice questions. Self-confidence was measured using the previously validated EBUS-Subjective Assessment Tool. Procedural skills assessment was performed on Simbionix BRONCH Express simulator and was modeled on a previously validated EBUS-Skills and Task Assessment Tool (EBUS-STAT), to create a modified EBUS-STAT based on internal faculty input via the Delphi method. After baseline testing, fellows participated in a structured multimodal curriculum, which included simulator training, small-group didactics, and interactive problem-based learning sessions, followed by individual debriefing sessions. Posttest assessment using the same three-part assessment tool was performed after 3 months, and the results were compared to study the impact of the new curriculum. Results: The mean knowledge score improved significantly from baseline to posttest (52.7% vs. 67.7%; P=0.002). The mean EBUS-Subjective Assessment Tool confidence scores (maximum score, 50) improved significantly from baseline to posttest (26 +/- 7.6 vs. 35.2 +/- 6.3 points; P < 0.001). The mean modified EBUS-STAT (maximum score, 105) improved significantly from baseline to posttest (44.8 +/- 10.6 [42.7%] vs. 65.3 +/- 11.4 [62.2%]; P < 0.001). There was a positive correlation (r=0.81) between the experience of the test participants and the modified EBUS-STAT scores. Conclusion: This study suggests a multimodal simulation-based curriculum can significantly improve EBUS-guided transbronchial needle aspiration-related knowledge, self-confidence, and procedural skills among novice pulmonary fellows. A validation study is needed to determine if skills attained via a simulator can be replicated in a clinical setting.