Flexible Bronchoscopy Simulation as a Tool to Improve Surgical Skills in Otolaryngology Residency

Chloe Santa Maria; Chi-Kwang Sung; Jennifer Y Lee; Dinesh K Chhetri; Abie H Mendelsohn; Karuna Dewan

doi:10.1177/2473974X211056530

Flexible Bronchoscopy Simulation as a Tool to Improve Surgical Skills in Otolaryngology Residency

OTO Open. 2021 Oct 29;5(4):2473974X211056530. doi: 10.1177/2473974X211056530. eCollection 2021 Oct-Dec.

Authors

Chloe Santa Maria¹, Chi-Kwang Sung¹, Jennifer Y Lee¹, Dinesh K Chhetri², Abie H Mendelsohn², Karuna Dewan¹

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA.
² Department of Otolaryngology-Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA.

Abstract

Objective: To evaluate the benefits of simulation to teach flexible bronchoscopy.

Study design: A prospective cohort study to assess the bronchoscopic skills of residents in an otolaryngology training program using a commercially available bronchoscopy simulator.

Setting: Tertiary care otolaryngology residency program.

Methods: Thirty-two otolaryngology residents and 4 expert faculty across 2 academic institutions were assessed on 3 flexible bronchoscopy tasks: diagnostic bronchoscopy, foreign body removal, and tracheal lesion biopsy. Performance was evaluated with a modified version of the validated Bronchoscopy Skills and Tasks Assessment Tool. At 1 of the 2 academic institutions, an additional tool was implemented to evaluate the simulator.

Results: There was a correlation between postgraduate training year and time taken to complete tasks, including bronchoscopy, foreign body extraction, and passing through the glottis (P < .001, P = .04, and P < .01, respectively). There was a significant difference between residents and faculty laryngologists for a range of skills and tasks, including percentage of time in middle lumen, contact with bronchial walls, inadvertent esophagus entry, and biopsy of healthy tissue (P < .001, P = .003, P < .001, and P < .001). Additionally, increasing postgraduate level was correlated with a higher percentage of time in the center of the lumen and reduced time to task completion (P = .05 and P < .001). Of 32 residents, 20 evaluated the simulator on its realism, with an average score of 4.1 of 5.

Conclusion: The commercially available flexible bronchoscopy simulator provides a valid assessment of bronchoscopic skill and is a useful tool for practicing bronchoscopy in a safe, controlled environment.

Level of evidence: Individual cohort study.

Keywords: bronchoscopy; resident training.