Learning curves for bronchoscopy and simulation
Editor – Further to Dr Holyoake's comments about virtual bronchoscopy simulation (Clin Med April 2013 pp214), I would also support the use of such technology in terms of improving preparation prior to ‘hands on’ training or to consolidate learning. However, studies are limited on this in the literature and a recent systematic review did show some evidence favouring simulation.1 It is unsurprising that simulation would be of benefit as studies of the effects of the European Working Time Directive have shown a significant impact on the number of bronchoscopy procedures undertaken by higher specialist trainees (greater than 30% in one study).2
In the field of ultrasound bronchoscopy (used here as a surrogate for conventional bronchoscopy), cumulative summation analysis and other studies have shown that the learning curve is very variable, hard to predict and may be longer than thought, even among experienced bronchoscopists.3,4 Simulation is also being trialled here with some initial promise.5 Similarly for conventional bronchoscopy, one would expect different rates of learning among novices who have never performed bronchoscopy. Cumulative summation analysis is a good way of documenting rates of procedural learning.
With regard to Dr Holyoakes’ other comments, it is of course important that simulation reflects real life too. Therefore, the orientation of the simulator should actually encompass both intubation from behind the supine patient (as commonly done in intensive care, interventional and ultrasound bronchoscopy,6 and conventional bronchoscopy) and intubation from in front and to the side of a patient lying at 45 degrees (also commonly but not exclusively used for conventional bronchoscopy). As respiratory physicians need to be able to bronchoscope from both positions, learning both is important.
Finally, I note Dr Holyoake is a clinical oncologist by specialty, which illustrates there is a demand in non-respiratory higher specialist trainees to learn bronchoscopy in view of techniques such as bronchoscope-guided radiofrequency ablation and brachytherapy (anaesthetics and interventional radiology being the other specialties). It will be important for those with responsibility for bronchoscopy learning programmes to facilitate such cross-specialty interest without any negative impact on learning opportunities for higher specialist respiratory trainees. In this respect also, virtual bronchoscopy simulation is a welcome development.
Footnotes
Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine{at}rcplondon.ac.uk
- © 2013 Royal College of Physicians
References
- ↵
- Kennedy CC,
- Maldonado F,
- Cook DA
- ↵
- Medford AR
- ↵
- Kemp SV,
- El Batrawy SH,
- Harrison RN,
- et al.
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