Training perspective: The impact of starting an endobronchial ultrasound program at a major academic center on fellows training of transbronchial needle aspiration

The proliferation of endobronchial ultrasound as the standard of care in lymph node sampling has significantly impacted the way fellows are trained in transbronchial needle aspiration (TBNA). To assess the impact of starting an endobronchial ultrasound (EBUS) program on fellows training of conventional TBNA (cTBNA), we reviewed all TBNAs performed at the Johns Hopkins Hospital from September 2006 until December of 2009. The number of nodes sampled, specimen adequacy, diagnostic yield, and fellow involvement were recorded. We found that the initiation of an EBUS program was associated with a significantly increased number of cases performed, as well as a significantly higher diagnostic yield, when compared with cTBNA. There was an associated significant decline in the number of cTBNA procedures performed by the pulmonary fellows, as well as the diagnostic yield and accuracy, when compared with EBUS. As interventional pulmonology fellowships and the overall use of EBUS become more prevalent, institutions will need to consider how to train their fellows in lymph node sampling.