Wet Laboratory Versus Computer Simulation for Learning Endobronchial Ultrasound: A Randomized Trial
BACKGROUND: Linear endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) is a revolutionary bronchoscopic procedure that is challenging to learn.OBJECTIVES: To compare two methods used to teach EBUS-TBNA: wet laboratory (lab) versus computer EBUS-TBNA simulation.METHODS: A prospective, randomized study of respirologists, thoracic surgeons and trainees learning EBUS-TBNA at a two-day continuing medical education course. All subjects received education via a series of lectures and live cases, followed by randomization to learn EBUS-TBNA predominantly either by wet lab simulation (n=6) or computer simulation (n=6). All subjects then completed testing of their EBUS-TBNA skills via a previously validated method using simulated cases on EBUS-TBNA simulators and questionnaires evaluating learner preferences.RESULTS: There were no significant differences between the computer EBUS-TBNA simulator group and the wet lab group in procedure time (25.3±6.1 min versus 25.2±2.5 min; P=0.984) and percentage of successful biopsies (81.3±14.9% versus 74.0±17.3%; P=0.453). The computer simulator group performed significantly better than the wet lab group in the percentage of lymph nodes correctly identified (70.4±16.7% versus 42.9±19.9%; P=0.002). Wet lab simulation was associated with increased learner confidence with operating the real EBUS-TBNA bronchoscope. All subjects responded that wet lab and computer EBUS-TBNA simulation offered important complementary learning opportunities.DISCUSSION: Computer EBUS-TBNA simulation leads to improved skill at correctly identifying lymph nodes, while wet lab simulation provided increased learner confidence due to increased realism.CONCLUSION: Computer EBUS-TBNA simulation and wet lab simulation are effective methods of learning basic EBUS-TBNA skills and appeared to be complementary.