Development of Learning Curves for Bronchoscopy Results of a Multicentre Study of Pulmonary Trainees.

Abstract Background There are currently no reference standards for the development of competency in bronchoscopy. Research Question The aims of this study were to 1) develop learning curves for bronchoscopy skill development and 2) estimate the number of bronchoscopies required to achieve competence. Study Design and Methods Trainees from seven North American academic centers were enrolled at the beginning of their Pulmonology training. Performance during clinical bronchoscopies was assessed by supervising physicians using the Ontario Bronchoscopy Assessment Tool (OBAT). Group-level learning curves were modelled using a quantile regression growth model, where the dependent variable was the mean OBAT score and the independent variable was the number of bronchoscopies performed at the time the OBAT was completed. Results A total of 591 OBAT assessments were collected from 31 trainees. The estimated regression quantiles illustrate significantly different learning curves based on trainees’ performance percentiles. When competence was defined as the mean OBAT score for all bronchoscopies rated as being completed without need for supervision, the mean OBAT score associated with competence was 4.54 (95% confidence interval: 4.47-4.58). Using this metric, the number of bronchoscopies required to achieve this score varied from 7-10 for the 90th percentile of trainees to 109-126 for the lowest 10th percentile of trainees. When competence was defined as the mean OBAT score for the first independent bronchoscopy, the mean was 4.40 (95% CI: 4.20-4.60). Based on this metric, the number of bronchoscopies required varied from 1-11 for the 90th percentile of trainees to 83-129 for the lowest 10th percentile of trainees Interpretation We were able to generate learning curves for bronchoscopy across a range of trainees and centers. Furthermore, we established the average number of bronchoscopies required for the attainment of competency. This information can be used for purposes of curriculum planning and allow trainee’s progress to be compared to an established norm.