Research
Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital
Published

Impact of simulation training on performance and outcomes of endobronchial ultrasound-guided transbronchial needle aspiration performed by trainees in a tertiary academic hospital

Research output: Contribution to journalJournal articleResearchpeer-review

DOI

  1. Society for Translational Medicine expert consensus on the use of antibacterial drugs in thoracic surgery

    Research output: Contribution to journalReviewResearchpeer-review

  2. Borderline multivessel coronary artery disease assessed by fractional flow reserve-affecting practice?

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Postoperative complications and survival after surgical resection of esophageal squamous cell carcinoma

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Developing competency in video-assisted thoracic surgery (VATS) lobectomy

    Research output: Contribution to journalJournal articleResearchpeer-review

  • Alvin Shao Qiang Ong
  • Aik Hau Tan
  • Devanand Anantham
  • Kiran Sharma
  • Shera Tan
  • Therese Sophie Lapperre
  • Kah Yee Tham
  • Rehena Sultana
  • Mariko Siyue Koh
View graph of relations

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has a high diagnostic yield and low complication rate. Whilst it has been included in international guidelines for the diagnosis and staging of lung cancer, current results are mostly based on EBUS experts performing EBUS-TBNA in centres of excellence. The impact of simulation training on diagnostic yield, complications, scope damage and repair cost in a real-world teaching hospital is unclear.

Methods: A review of our hospital EBUS-TBNA registry from August 2008 to December 2016 was performed. A positive diagnosis was defined as a confirmed histological or microbiological diagnosis based on EBUS sampling. Complications were classified as major or minor according to the British Thoracic Society guidelines. In addition, we assessed the cost of repairs for scope damage before and after simulation training was implemented. Using CUSUM analysis, the learning curves of individual trainees and the institution were plotted.

Results: There were 608 EBUS-TBNA procedures included in the study. The number of procedures performed by trainees who underwent conventional training was 331 and those who underwent simulation training performed 277 procedures. Diagnostic yield for trainees without simulation training was 88.2% vs. 84.5% for trainees with simulation training (P=0.179). There was no statistical difference in the diagnostic yield between the groups of trainees (OR: 0.781, 95% CI: 0.418-1.460, P=0.438) after adjusting for risk factors. There was an increase in overall complications from 13.6% to 16.6% (OR: 2.247, 95% CI: 1.297-3.891, P=0.004) after introduction of the simulation training, but a trend to decrease in major complications 3.6% to 0.7% (P=0.112). The cost for scope repairs for the trainees without simulation training was SGD 413.88 per procedure vs. SGD 182.79 per procedure for the trainees with simulation training, with the mean difference being SGD 231.09 per procedure (95% CI: 178.40-640.60, P=0.268). CUSUM analysis showed an increasing learning curve for the trainees with simulation training after an initial competency period.

Conclusions: There was no statistical difference in diagnostic yield from EBUS-TBNA and cost of scope damage after simulation training was introduced into our training program. Interestingly, there was an increase in minor complications. CUSUM analysis can provide additional information on institutional learning curves. The value of simulation training in EBUS-TBNA remains uncertain.

Original languageEnglish
JournalJournal of Thoracic Disease
Volume10
Issue number9
Pages (from-to)5621-5635
Number of pages15
ISSN2072-1439
DOIs
Publication statusPublished - Sep 2018

ID: 56349726