Virtual reality bronchoscopy simulation - A revolution in procedural training

Background: In the airline industry,, training is costly and operator error must be avoided. Therefore, virtual reality (NR) is routinely used to lean manual and technical skills through simulation before pilots assume flight responsibilities. In the field of medicine, manual and technical skills mu st also be acquired to competently, perform invasive procedures such as fle xible fiberoptic bronchoscopy (FFB). Until recently, training in FFB and ot her endoscopic procedures has occurred on the job in real patients. We hypo thesized that novice trainees using a NP. skill center could rapidly acquir e basic skills, and that results would compare favorably with those of seni or trainees trained in the conventional manner. Methods: We prospectively studied five novice bronchoscopists entering a pu lmonary and critical care medicine training program. They were taught to pe rform inspection flexible bronchoscopy using a NCR bronchoscopy skill cente r; dexterity, speed, and accuracy were tested using the skill center and an inanimate airway model before and after 4 h of group instruction and 4 h o f individual unsupervised practice. Results were compared to those of a control group of four skilled physician s who had performed at least 200 bronchoscopies during 2 years of training. Student's t tests were used to compare mean scores of study and control gr oups for the inanimate model and VR bronchoscopy simulator. Before-training and after-training test scores were compared using pained t tests. For com parisons between after-training novice and skilled physician scores, unpair ed two-sample t tests were used. Results: Novices significantly improved th eir dexterity and accuracy in both models. They, missed fewer segments afte r training than before training, and had fewer contacts with the bronchial wall. There vans no statistically significant improvement in speed or total time spent not visualizing airway anatomy. After training, novice performa nce equaled or sw-passed that of the skilled physicians. Novices performed more thorough examinations and missed significantly fewer segments in both the inanimate and virtual simulation models. Conclusion: A short, focused course of instruction and unsupervised practic e using a virtual bronchoscopy simulator enabled novice trainees to attain a level of manual and technical skill at performing diagnostic bronchoscopi c inspection similar to those of colleagues with several years of experienc e. These skills were readily reproducible in a conventional inanimate airwa y-training model, suggesting they, would also be translatable to direct pat ient care.