A Comparison of Different Training Methods in the Successful Learning of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

Wen Chao Zhang, Wei Chen, Jian Ping Zhou, Andrew D. Lerner, Lei Ni, Ji Min Shen, Tian Li Yan, Min Zhou, Guo Chao Shi, Yi Xiang

Research output: Contribution to journalArticlepeer-review


Background: Standardized training of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS- TBNA) is available only in highly developed countries. Objective: To compare the skill differences in the performance of EBUS-TBNA by pulmonologists trained under different learning methods. Methods: We performed a retrospective study of 145 EBUS-TBNA cases. We set up 3 comparative training groups: a standardized training group, a teaching group, and a self-study group. The main clinical outcomes were sensitivity, specificity and accuracy of EBUS-TBNA. Cumulative sum analysis was used to track EBUS-TBNA proficiency of the 3 groups. Results: The sensitivities of EBUS-TBNA in the different groups were 90, 88, and 67%, respectively. The accuracies of the different groups were 91, 90, and 71%, respectively. With respect to the sensitivity and accuracy, there was no significant difference between the standardized training group and teaching group. However, the self-study group was inferior to the other 2 groups. By comparing the learning curve among the groups, we found that the minimum number of operations needed to reach a 90% accuracy for the standardized training group, the teaching group and the self-study group was 17, 32 and 40 cases, respectively. Conclusion: Compared with the teaching and self-study groups, the standardized training group resulted in practitioners achieving high skill levels following the performance of a lower number of cases. Pulmonologists trained in the teaching group achieved a similar level of skills, but required more experience to reach this level. Practitioners in the self-study group did not achieve a satisfactory level of skills, despite performing a high number of cases.

Original languageEnglish (US)
Pages (from-to)319-326
Number of pages8
Issue number5
StatePublished - Apr 1 2017


  • Cumulative sum analysis
  • Endobronchial ultrasound-guided transbronchial needle aspiration
  • Learning curve
  • Lung cancer
  • Training methods

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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