TY - JOUR
T1 - Development of Learning Curves for Bronchoscopy
T2 - Results of a Multicenter Study of Pulmonary Trainees
AU - Voduc, Nha
AU - Adamson, Rosemary
AU - Kashgari, Alia
AU - Fenton, Mark
AU - Porhownick, Nancy
AU - Wojnar, Margaret
AU - Sharma, Krishna
AU - Gillson, Ashley Mae
AU - Chung, Carol
AU - McConnell, Meghan
N1 - Funding Information:
FUNDING/SUPPORT: Funding for this study was provided by a Medical Education Research Grant from the Royal College of Physicians and Surgeons of Canada .
Publisher Copyright:
© 2020 American College of Chest Physicians
PY - 2020/12
Y1 - 2020/12
N2 - 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.
AB - 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.
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U2 - 10.1016/j.chest.2020.06.046
DO - 10.1016/j.chest.2020.06.046
M3 - Article
C2 - 32622822
AN - SCOPUS:85096609076
SN - 0012-3692
VL - 158
SP - 2485
EP - 2492
JO - CHEST
JF - CHEST
IS - 6
ER -