Developments in Simulation Bronchoscopy Training


Flexible bronchoscopy is a common procedure. Training in bronchoscopy is a complex process involving learning technical skills, understanding indications and contraindications, risks and benefits of the procedure, working within the team and communicating with patients. It is expected that a competent bronchoscopist is able to maneuver the scope through the anatomically complex bronchial tree, take samples, manage the sedated patient and communicate with nursing staff. Learning the complex procedural skills in the clinical setting can be stressful, therefore current bronchoscopic training methodology should blend a number of learning methods including didactic lectures, web-based material, high and low fidelity simulators as well as supervised apprenticeship training. Simulation-based bronchoscopy training therefore has been explored as a mode of training bronchoscopy skills. In this article, the role of simulation-based bronchoscopy training is reviewed. The low fidelity and high fidelity virtual reality bronchoscopy models are described together with the evidence available to support the use of simulation for bronchoscopy training.

Share and Cite:

J. Kastelik, F. Chowdhury, S. Pathmanathan, I. Aslam, J. Hogg and J. Morjaria, "Developments in Simulation Bronchoscopy Training," Open Journal of Respiratory Diseases, Vol. 3 No. 4, 2013, pp. 154-163. doi: 10.4236/ojrd.2013.34024.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] A. Ernst, G. A. Silvestri and D. Johnstone, “Interventional Pulmonary Procedures: Guidelines from the American College of Chest Physicians,” Chest, Vol. 123, No. 5, 2003, pp. 1693-1717.
[2] G. A. Silvestri, D. Feller-Kopman, A. Chen, M. Wahidi, K. Yasufuku and A. Ernst, “Latest Advances in Advanced Diagnostic and Therapeutic Pulmonary Procedures,” Chest, Vol. 142, No. 6, 2012, pp. 1636-1644.
[3] P. A. Kvale and A. C. Mehta, “Training Bronchoscopists for the New Era,” Clinics in Chest Medicine, Vol. 22, No. 2, 2001, pp. 365-372.
[4] J. E. Rayl, J. M. Pittman and J. J. Shuster, “Preclinical Training in Bronchoscopic Diagnosis of Cancer,” Chest, Vol. 93, No. 4, 1988, pp. 824-827.
[5] G. A. Silvestri, “The Evolution of Bronchoscopy Training,” Respiration; International Review of Thoracic Diseases, Vol. 76, No. 1, 2008, pp. 9-20.
[6] M. Davoudi and H. G. Colt, “Bronchoscopy Simulation: A Brief Review,” Advances in Health Sciences Education: Theory and Practice, Vol. 14, No. 2, 2009, pp. 287-296.
[7] E. F. Haponik, G. B. Russell, J. F. Beamis Jr., E. J. Britt, P. Kvale, P. Mathur and A. Mehta, “Bronchoscopy Training: Current Fellows’ Experiences and Some Concerns for the Future,” Chest, Vol. 118, No. 4, 2000, pp. 625-630.
[8] M. R. Lucarelli, C. R. Lucey and J. G. Mastronarde, “Survey of Current Practices in Fellowship Orientation,” Respiration, Vol.74, No.4, 2007, pp.382-386.
[9] W. C. McGaghie, V. J. Siddall, P. E. Mazmanian and J. Myers, “Lessons for Continuing Medical Education from Simulation Research in Undergraduate and Graduate Medical Education: Effectiveness of Continuing Medical Education: American College of Chest Physicians Evidence-Based Educational Guidelines,” Chest, Vol. 135, No. 3, 2009, pp. 62S-68S.
[10] D. Ost, A. DeRosiers, E. J. Britt, A. M. Fein, M. L. Lesser and A. C. Mehta, “Assessment of a Bronchoscopy Simulator,” American Journal of Respiratory and Critical Care Medicine, Vol. 164, No. 5, 2001, pp. 2248-2255.
[11] M. Davoudi, S. Quadrelli, K. Osann and H. G. Colt, “A Competency-Based Test of Bronchoscopic Knowledge Using the Essential Bronchoscopist: An Initial Concept Study,” Respirology, Vol. 13, No. 5, 2008, pp. 736-743.
[12] M. M. Wahidi, G. A. Silvestri, R. D. Coakley, J. S. Ferguson, R. W. Shepherd, L. Moses, J. Conforti, L. G. Que, K. J. Anstrom, F. McGuire, H. Colt and G. H. Downie, “A Prospective Multicenter Study of Competency Metrics and Educational Interventions in the Learning of Bronchoscopy among New Pulmonary Fellows,” Chest, Vol. 137, No. 5, 2010, pp. 1040-1049.
[13] S. Quadrelli, M. Davoudi, F. Galindez and H. G. Colt, “Reliability of a 25-Item Low-Stakes Multiple-Choice Assessment of Bronchoscopic Knowledge,” Chest, Vol. 135, No. 2, 2009, pp. 315-321.
[14] M. H. Dykes and A. Ovassapian, “Dissemination of Fibreoptic Airway Endoscopy Skills by Means of a Workshop Utilizing Models,” British Journal of Anaesthesia, Vol. 63, No. 5, 1989, pp. 595-597.
[15] A. Ovassapian, M. H. Dykes and M. E. Golmon, “A Training Programme for Fibreoptic Nasotracheal Intubation. Use of Model and Live Patients,” Anaesthesia, Vol. 38, No. 8, 1983, pp. 795-798.
[16] R. E. Wood and J. R. Pick, “Model Systems for Learning Pediatric Flexible Bronchoscopy,” Pediatric Pulmonology, Vol. 8, No. 3, 1990, pp. 168-171.
[17] N. J. Maran and R. J. Glavin, “Low- to High-Fidelity Simulation—A Continuum of Medical Education?” Medical Education, Vol. 37, Suppl. 1, 2003, pp. 22-28.
[18] I. Choy and A. Okrainec, “Simulation in Surgery: Perfecting the Practice,” The Surgical Clinics of North America, Vol. 90, No. 3, 2010, pp. 457-473.
[19] R. J. Scalese, V. T. Obeso and S. B. Issenberg, “Simulation Technology for Skills Training and Competency Assessment in Medical Education,” Journal of General Internal Medicine, Vol. 23, Suppl. 1, 2008, pp. 46-49.
[20] R. H. Steadman, W. C. Coates, Y. M. Huang, R. Matevosian, B. R. Larmon, L. McCullough and D. Ariel, “Simulation-Based Training Is Superior to Problem-Based Learning for the Acquisition of Critical Assessment and Management Skills,” Critical Care Medicine, Vol. 34, No. 1, 2006, pp. 151-157.
[21] W. T. Mason and P. W. Strike, “See One, Do One, Teach One—Is This Still How It Works? A Comparison of the Medical and Nursing Professions in the Teaching of Practical Procedures,” Medical Teacher, Vol. 25, No. 6, 2003, pp. 664-666.
[22] J. M. Rodriguez-Paz, M. Kennedy, E. Salas, A. W. Wu, J. B. Sexton, E. A. Hunt and P. J. Pronovost, “Beyond ‘See One, Do One, Teach One’: Toward a Different Training Paradigm,” Quality and Safety in Health Care, Vol. 18, No. 1, 2009, pp. 63-68.
[23] N. J. Pastis, P. J. Nietert and G. A. Silvestri, “Variation in Training for Interventional Pulmonary Procedures among Us Pulmonary/Critical Care Fellowships: A Survey of Fellowship Directors,” Chest, Vol. 127, No. 5, 2005, pp. 1614-1621.
[24] D. R. Stather, J. Jarand, G. A. Silvestri and A. Tremblay, “An Evaluation of Procedural Training in Canadian Respirology Fellowship Programs: Program Directors’ and Fellows’ Perspectives,” Canadian Respiratory Journal: Journal of the Canadian Thoracic Society, Vo. 16, No. 2, 2009, pp. 55-59.
[25] K. G. Torrington, “Bronchoscopy Training and Competency: How Many Are Enough?” Chest, Vol. 118, No. 3, 2000, pp. 572-573.
[26] H. G. Colt, M. Davoudi, S. Murgu and N. Zamanian Rohani, “Measuring Learning Gain during a One-Day Introductory Bronchoscopy Course,” Surgical Endoscopy, Vol. 25, No. 1, 2011, pp. 207-216.
[27] W. C. McGaghie, S. B. Issenberg, E. R. Petrusa and R. J. Scalese, “A Critical Review of Simulation-Based Medical Education Research: 2003-2009,” Medical Education, Vol. 44, No. 1, 2010, pp. 50-63.
[28] B. Ram, M. Oluwole, R. L. Blair, R. Mountain, P. Dunkley and P. S. White, “Surgical Simulation: An Animal Tissue Model for Training in Therapeutic and Diagnostic Bronchoscopy,” The Journal of Laryngology and Otology, Vol. 113, No. 2, 1999, pp. 149-151.
[29] A. Ovassapian, S. J. Yelich, M. H. Dykes and M. E. Golman, “Learning Fibreoptic Intubation: Use of Simulators v. Traditional Teaching,” British Journal of Anaesthesia, Vol. 61, No. 2, 1988, pp. 217-220.
[30] R. Goldberg, H. G. Colt, M. Davoudi and L. Cherrison, “Realistic and Affordable Lo-Fidelity Model for Learning Bronchoscopic Transbronchial Needle Aspiration,” Surgical Endoscopy, Vol. 23, No. 9, 2009, pp. 2047-2052.
[31] M. Davoudi, M. M. Wahidi, N. Zamanian Rohani and H. G. Colt, “Comparative Effectiveness of Low- and High- Fidelity Bronchoscopy Simulation for Training in Conventional Transbronchial Needle Aspiration and User Preferences,” Respiration, Vol. 80, No. 4, 2010, pp. 327-334.
[32] A. H. Meier, C. L. Rawn and T. M. Krummel, “Virtual Reality: Surgical Application— Challenge for the New Millennium,” Journal of the American College of Surgeons, Vol. 192, No. 3, 2001, pp. 372-384.
[33] K. Moorthy, S. Smith, T. Brown, S. Bann and A. Darzi, “Evaluation of Virtual Reality Bronchoscopy as a Learning and Assessment Tool,” Respiration diseases, Vol. 70, No. 2, 2003, pp. 195-199.
[34] M. Davoudi, K. Osann and H. G. Colt, “Validation of Two Instruments to Assess Technical Bronchoscopic Skill Using Virtual Reality Simulation,” Respiration, Vol. 76, No. 1, 2008, pp. 92-101.
[35] R. Aggarwal, T. Grantcharov, K. Moorthy, J. Hance and A. Darzi, “A Competency-Based Virtual Reality Training Curriculum for the Acquisition of Laparoscopic Psychomotor Skill,” American Journal of Surgery, Vol. 191, No. 1, 2006, pp. 128-133.
[36] S. Arora, D. Miskovic, L. Hull, K. Moorthy, R. Aggarwal, H. Johannsson, S. Gautama, R. Kneebone and N. Sevdalis, “Self vs Expert Assessment of Technical and Non-Technical Skills in High Fidelity Simulation,” American Journal of Surgery, Vol. 202, No. 4, 2011, pp. 500-506.
[37] C. P. Marsland, B. J. Robinson, C. H. Chitty and B. J. Guy, “Acquisition and Maintenance of Endoscopic Skills: Developing an Endoscopic Dexterity Training System for Anesthesiologists,” Journal of Clinical Anesthesia, Vol. 14, No. 8, 2002, pp. 615-619.
[38] K. M. Martin, P. D. Larsen, R. Segal and C. P. Marsland, “Effective Nonanatomical Endoscopy Training Produces Clinical Airway Endoscopy Proficiency,” Anesthesia and Analgesia, Vol. 99, No. 3, 2004, pp. 938-944.
[39] J. S. Chen, H. H. Hsu, I. R. Lai, H. C. Tai, H. S. Lai, Y. C. Lee, J. S. Shaw, Y. P. Hung, P. H. Lee and K. J. Chang, “Validation of a Computer-Based Bronchoscopy Simulator Developed in Taiwan,” Journal of the Formosan Medical Association, Vol. 105, No. 7, 2006, pp. 569-576.
[40] R. Rowe and R. A. Cohen, “An Evaluation of a Virtual Reality Airway Simulator,” Anesthesia and Analgesia, Vol. 95, No. 1, 2002, pp. 62-66.
[41] M. G. Blum, T. W. Powers and S. Sundaresan, “Bronchoscopy Simulator Effectively Prepares Junior Residents to Competently Perform Basic Clinical Bronchoscopy,” The Annals of Thoracic Surgery, Vol. 78, No. 1, 2004, pp. 287-291.
[42] C. C. Kennedy, F. Maldonado and D. A. Cook, “Simulation-Based Bronchoscopy Training: Systematic Review and Meta-Analysis,” Chest, Vol. 144, No. 1, 2013, pp. 183-192.
[43] O. J. Hilmi, P. S. White, D. W. McGurty and M. Oluwole, “Bronchoscopy Training: Is Simulated Surgery Effective?” Clinical Otolaryngology and Allied Sciences, Vol. 27, No. 4, 2002, pp. 267-269.
[44] S. Ameur, K. Carlander, K. Grundstrom, P. Hallberg, K. Lundgren, P. G. Lundquist and T. Wikstrom, “Learning Bronchoscopy in Simulator Improved Dexterity Rather than Judgement,” Lakartidningen, Vol. 100, No. 35, 2003, pp. 2694-2699.
[45] F. Agro, F. Sena, E. Lobo, S. Scarlata, N. Dardes and G. Barzoi, “The Dexter Endoscopic Dexterity Trainer Improves Fibreoptic Bronchoscopy Skills: Preliminary Observations,” Canadian Journal of Anaesthesia, Vol. 52, No. 2, 2005, pp. 215-216.
[46] E. S. Deutsch, T. Christenson, J. Curry, J. Hossain, K. Zur and I. Jacobs, “Multimodality Education for Airway Endoscopy Skill Development,” The Annals of Otology, Rhinology, and Laryngology, Vol. 118, No. 2, 2009, pp. 81-86.
[47] N. Jabbour, T. Reihsen, R. M. Sweet and J. D. Sidman, “Psychomotor Skills Training in Pediatric Airway Endoscopy Simulation,” Otolaryngology—Head and Neck Surgery, Vol. 145, No. 1, 2011, pp. 43-50.
[48] D. R. Stather, P. Maceachern, K. Rimmer, C. A. Hergott and A. Tremblay, “Assessment and Learning Curve Evaluation of Endobronchial Ultrasound Skills Following Simulation and Clinical Training,” Respirology, Vol. 16, No. 4, 2011, pp. 698-704.
[49] D. R. Stather, P. MacEachern, A. Chee, E. Dumoulin and A. Tremblay, “Evaluation of Clinical Endobronchial Ultrasound Skills Following Clinical versus Simulation Training,” Respirology, Vol. 17, No. 2, 2012, pp. 291-299.
[50] S. W. Crawford and H. G. Colt, “Virtual Reality and Written Assessments Are of Potential Value to Determine Knowledge and Skill in Flexible Bronchoscopy,” Respiration, Vol. 71, No. 3, 2004, pp. 269-275.
[51] H. G. Colt, S. W. Crawford and O. Galbraith III, “Virtual Reality Bronchoscopy Simulation: A Revolution in Procedural Training,” Chest, Vol. 120, No. 4, 2001, pp. 1333-1339.
[52] J. E. Smith, A. P. Jackson, J. Hurdley and P. J. Clifton, “Learning Curves for Fibreoptic Nasotracheal Intubation When Using the Endoscopic Video Camera,” Anaesthesia, Vol. 52, No. 2, 1997, pp. 101-106.
[53] R. M. Fanning and D. M. Gaba, “The Role of Debriefing in Simulation-Based Learning,” Simulation in Healthcare, Vol. 2, No. 2, 2007, pp. 115-125.
[54] T. McCashland, R. Brand, E. Lyden and P. de Garmo, “The Time and Financial Impact of Training Fellows in Endoscopy. Cori Research Project. Clinical Outcomes Research Initiative,” The American Journal of Gastroenterology, Vol. 95, No. 11, 2000, pp. 3129-3132.
[55] R. M. Epstein, “The Costs of Making Practice More Cost-Effective,” JAMA: The Journal of the American Medical Association, Vol. 287, No. 13, 2002, pp. 1648-1649.
[56] J. B. Cooper and V. R. Taqueti, “A Brief History of the Development of Mannequin Simulators for Clinical Education and Training,” Postgraduate Medical Journal, Vol. 84, No. 997, 2008, pp. 563-570.
[57] M. Davoudi, H. G. Colt, K. E. Osann, C. R. Lamb and J. J. Mullon, “Endobronchial Ultrasound Skills and Tasks Assessment Tool: Assessing the Validity Evidence for a Test of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Operator Skill,” American Journal of Respiratory and Critical Care Medicine, Vol. 186, No. 8, 2012, pp. 773-779.

Copyright © 2022 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.