Evaluation of clinical endobronchial ultrasound skills following clinical versus simulation training

Background and objective: Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) is a pulmonary procedure that can be challenging to learn. This study aims to compare trainee EBUS-TBNA performance during clinical procedures, following training with a computer EBUS-TBNA simulator versus conventional clinical EBUS-TBNA training. Methods: A prospective study of pulmonary trainees performing EBUS-TBNA procedures on patients with suspected lung cancer and mediastinal adenopathy. Two cohorts of trainees were each evaluated while performing EBUS-TBNA on two patients. Group 1 received training by performing 15 cases on an EBUS-TBNA simulator (n = 4) and had never performed a clinical EBUS-TBNA procedure. Group 2 received training by doing 15-25 EBUS-TBNA procedures on patients (n = 4). Results: There was no significant difference in the primary outcome measure of total EBUS-TBNA procedure time/number of successful aspirates between Groups 1 and 2 (3.95 (+/-0.93) vs 3.64 (+/-0.89), P = 0.51). Total learner EBUS-TBNA procedure time in minutes (23.67 (+/-5.58) vs 21.81 (+/-5.36), P = 0.17) and percentage of successful aspirates (93.3% (+/-5.8%) vs 86.3% (+/-6.7%), P = 0.12) were not significantly different between Group 1 and Group 2. The only significant difference found between Group 1 and Group 2 was time to intubation in minutes (0.99 (+/-0.46) vs 0.50 (+/-0.42), P = 0.04). Conclusions: EBUS-TBNA simulator use leads to rapid acquisition of clinical EBUS-TBNA skills comparable with that obtained with conventional training methods using practiceonpatients, suggesting that skills learned using an EBUS-TBNA simulator are transferable to clinical EBUS-TBNA performance. EBUS-TBNA simulators show promise for training, potentially minimizing the burden of procedural learning on patients.