TRAINING BRONCHOSCOPISTS FOR THE NEW ERA - 03/09/11
Résumé |
Gustav Killian introduced bronchoscopy a little over 1 century ago. At that time, the only way others could learn how to perform bronchoscopy was by one-on-one tutoring, using a rigid bronchoscope with no side portals and no imaging devices such as a television camera and monitor. One-on-one teaching remains an integral part of learning how to perform bronchoscopy well, but many new technologies have emerged that make it far less labor intensive to train bronchoscopists. The flexible bronchoscope, which was developed in the 1960s, generally is regarded as an easier instrument to use than a rigid bronchoscope. Beam splitters became available in the 1970s, so the primary operator and the student could view the image at the same time. In the 1990s, charge-coupled device (CCD) technology allowed manufacturers to incorporate a chip into the tip of a flexible bronchoscope with digitization of the image and reconstruction of an analog image on a television monitor. Such monitors can be placed wherever they are wanted, allowing many students to observe the findings and the techniques of bronchoscopy at the same time. For “live” bronchoscopy of patients, a teacher of bronchoscopy still needs to be positioned at the tableside, in close proximity to the student, when the procedure is performed. This positioning allows the nuances of manipulating the bronchoscope and the various ancillary instruments (biopsy forceps, and so forth) to be taught as well. More recently, simulators have been developed for flexible bronchoscopy training, and most of what can be learned with live patients is reproduced well with these simulators.
The use of simulators is standard in many professions in which proper training can improve the safety of the task. Examples include the military,30 aviation,31 nuclear power,35 and aerospace industries.23 Simulators are used for training, rehearsal, and competency evaluation. Flight simulators are used to train novice and expert pilots before flying new types of aircraft, for example. Pilots must be certified on simulators before they are allowed to fly commercial planes.26
The application of simulation technology to endoscopic medical procedures began in the early 1990s, with the emphasis on gastrointestinal endoscopic procedures.4, 5, 13, 27, 36 The technology at that time was not advanced enough to produce realistic or affordable simulators. One of the biggest technical hurdles was that these simulators required computers that cost approximately $250,000. Fortunately, recent technologic advancement has allowed introduction of a flexible bronchoscopy simulator (FBSi) that is realistic and runs on a desktop personal computer.7 In addition to endoscopy, simulation technology is being applied to laparoscopy,12 anesthesia,10 cardiology,14 and percutaneous procedures.34 Physicians are beginning to realize the potential benefits of simulation, as evidenced by recent publications urging the medical community to adopt this technology for training and certification.9, 15, 17 Simulators offer the potential to minimize the necessity to learn and practice procedural skills on patients, allowing trainees to develop basic competence before treating patients. The justification of patients being subjected to the “see one, do one, teach one” training method is nearing the end. Although this phrase is used commonly in the back halls of medical training, responsible teachers always have felt the need to supervise students closely to optimize the learning process and ensure patient safety at the same time.
Now, however, simulators will replace the need to practice procedures on recently deceased patients, a practice coming under intense scrutiny lately.18 In addition, the use of animals for medical procedure training will become less necessary, reducing the high cost of operating animal laboratories.
Medical credentialing organizations, such as the American Board of Medical Specialties, also are beginning to investigate the use of simulation for evaluating clinical skills.32 Professional medical organizations such as the American College of Surgeons, the American Society of Gastrointestinal Endoscopists, the American Academy of Orthopedic Surgeons, the Society for Cardiovascular and Interventional Radiology, the American Urological Association, and the American College of Cardiology are investigating the use and development of medical simulators.
Le texte complet de cet article est disponible en PDF.Plan
| Address reprint requests to Paul A. Kvale, MD, Division of Pulmonary and Critical Care Medicine, 2799 West Grand Boulevard, Detroit, MI 48202 |
Vol 22 - N° 2
P. 365-372 - juin 2001 Retour au numéro
Article précédent
- RIGID BRONCHOSCOPY IN THE TWENTY-FIRST CENTURY
- Michael L. Ayers, John F. Beamis
- DOCUMENTATION IN BRONCHOLOGY
- Armin Ernst, Heinrich D. Becker
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?