A Multicenter Study Assessing Interventional Pulmonary Fellow Competency in Electromagnetic Navigation Bronchoscopy

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 ThiboutotJennifer Toth, Keriann Van Nostrand, Jason A. Akulian

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: Current medical society guidelines recommend a procedural number for obtaining electromagnetic navigational bronchoscopy (ENB) competency and for institutional volume for training. Objective: To assess learning curves and estimate the number of ENB procedures for interventional pulmonology (IP) fellows to reach competency.

Methods: We conducted a prospective multicenter study of IP fellows in the United States learning ENB. A tool previously validated in a similar population was used to assess IP fellows by their local faculty and two blinded independent reviewers using virtual recording of the procedure. Competency was determined by performing three consecutive procedures with a competency score on the assessment tool. Procedural time, faculty global rating scale, and periprocedural complications were also recorded. Results: A total of 184 ENB procedures were available for review with assessment of 26 IP fellows at 16 medical centers. There was a high correlation between the two blinded independent observers (rho = 0.8776). There was substantial agreement for determination of procedural competency between the faculty assessment and blinded reviewers (kappa = 0.7074; confidence interval, 0.5667–0.8482). The number of procedures for reaching competency for ENB bronchoscopy was determined (median, 4; mean, 5; standard deviation, 3.83). There was a wide variation in the number of procedures to reach competency, ranging from 2 to 15 procedures. There were six periprocedural complications reported, four (one pneumomediastinum, three pneumothorax) of which occurred before reaching competence and two pneumothoraces after achieving competence. Conclusion: There is a wide variation in acquiring competency for ENB among IP fellows. Virtual competency assessment has a potential role but needs further studies.

Original languageEnglish (US)
Pages (from-to)220-228
Number of pages9
JournalATS Scholar
Issue number2
StatePublished - Jun 2022

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine
  • Clinical Neurology
  • Education
  • Pulmonary and Respiratory Medicine


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