Learning electromagnetic navigational bronchoscopy and percutaneous transthoracic needle biopsy (LEAP): A pilot study

Background: Prior studies in pulmonology have examined the validity of procedural training tools, however, translation of simulation skill acquisition into real world competency remains understudied. We examine an assessment process with a simulation training course for electromagnetic navigational (EMN) bronchoscopy and percutaneous transthoracic needle aspiration (PTTNA). Methods: A cohort study was conducted by subjects using EMN bronchoscopy and PTTNA. A procedural assessment tool was developed to measure basic competency for EMN bronchoscopy and PTTNA at 3 different time points: First simulation case, final simulation case upon reaching a competent score, and at their first live case. The assessment tool was divided into 4 domains (total score, 4 to 16; competency ≤ 12) with each domain requiring a passing score (1 to 4; competency ≤ 3.0). Complication and procedural time were collected during their first live case. Results: Twenty-two serial procedures (12 EMN bronchoscopies, 10 EMN PTTNA) were observed by 14 subjects. The mean first simulation score for EMN bronchoscopy (4.66±0.89) improved after cadaver simulation (12.67}0.89, median 3 simulations attempts). The subjectsf mean score for their first live case was 13±0.85 (self-reported score 12.5±1.07). For EMN PTTNA, the mean first simulation score (4.3±2.40) improved after cadaver simulation (12.6±1.51, median 3 simulation attempts). The subjectsf mean score for their first live PTTNA case was 12.5±}2.87 (self-reported score 12.1±1.05). There was only 1 minor complication. Conclusion: Learning EMN bronchoscopy/PTTNA is feasible using a structured simulation course with an assessment tool.