Exploring competency in endobronchial ultrasonography (EBUS): Correlation between experience, self-assessment, theoretical knowledge, and technical performance

Background EBUS is the new gold standard for mediastinal sampling, but is difficult to learn and very operator-dependent. Competency is currently established based on experience (number of performed procedures), self-assessment (the physician9s own judgment), or the subjective opinion of a supervisor. Aims and objectives The aim of the study was to explore to what degree experience, self-assessment, and theoretical knowledge could predict the quality of an EBUS procedure. Our hypothesis was that experience would correlate better with actual performance than self-assessment and theoretical knowledge. Methods Thirty-one international physicians filled out a questionnaire regarding number of performed EBUS procedures and self-assessment of competency. Theoretical knowledge was assessed by administering a validated test with 46 questions. All participants performed an EBUS procedure including two biopsies on a virtual-reality simulator and previously validated simulator metrics were used for objective assessment of quality. Results Surprisingly, the number of correct answers on the theoretical test was the best predictor of technical performance (Pearson correlation=0.52, p=0.004). Experience and self-assessment were weak, insignificant predictors (Pearson correlations=0.01, p=0.59 and 0.18, p=0.35, respectively). Conclusions Caution has to be used when establishing basic competency in endosonography based on number of performed procedures or the perception of the physician. We propose to develop an evidence-based credentialing system consisting of theoretical and practical tests.