Effectiveness of simulation with virtual reality in bronchoscopy training

Simulation-based training is an emerging technique that provides an effective,zero-risk environment to teach procedures. The aim of this study was to investigate whether a high fidelity bronchoscopy simulator,the Simbionix Bronch Mentor™,could be an effective tool in improving the degree of competence among an eterogeneous cohort of bronchoscopists of different level of experience. Partecipants were 17 pulmonary fellows divided into 3 groups (Novice=5;Intermediate=6;Expert=6) who were evaluated at Simbionix during a short term simulation training in which 5 curricular tasks were performed (3 baseline-2 advanced procedures).Every group was tested at Time 0 in which none of the participants had never approached the simulator before this time,and Time 1, where all participants were re-tested individually and asked to repeat the same 5 tasks made at T0. Results showed a significative improvement between T0 and T1 for all groups of bronchoscopists, with Novice achieving the best upgrade from T0-T1 in basic tasks 1-2(scope manipulaton, anatomic navigation) compared to other two groups. Task 3 (nomenclature task)showed a statistically significative improvement only for Novice,while Task 4(Lns identificaton)revealed a remarkable improvement in recognition of major number of lymph nodes at T1 for whole bronchoscopsts,but a significative reduction in time at T1 only for Intermediate and Expert.Task 5(EBUS-TBNA) documented a significative reduction in time and increase in samples obtained at T1 comparable for all three groups(none of the partecipants had previous experience of EBUS). Our results suggest the validity of Simulator in a standardised programme of bronchoscopy training suitable for each level of competence.