Cognitive Task Analysis Of Flexible Bronchoscopy For The Design Of Simulation-Based Training

Objective: Simulators allow trainees to acquire basic skills for flexible bronchoscopy (FB) before practice on a patient. The aim of the current study was to gain insight into the required skills for FB, their underlying cognitive aspects and to what extent they can be trained on a virtual-reality (VR) simulator. Method: Four established FB guidelines and a simulation-based FB curriculum were analyzed to identify essential steps in FB and used as input for a semi-structured interview. A retrospective think-aloud study was performed combined with a semi-structured interview. Six experts performed a diagnostic FB on a VR simulator which was video-recorded. Participants engaged in retrospective think-aloud while watching their performance on video. A semi-structured interview helped clarify concepts and opinions about simulation-based training. Results: Experts agreed that two types of skills can be trained on the VR simulator: handling of the bronchoscope and inspecting the airway. For other FB related skills, such as taking biopsies or dealing with complications, the VR simulator was too inaccurate for either training or assessment. The results from this study provide detailed descriptions of relevant cues, training goals, and experienced difficulties. Discussion: Simulation-based training for flexible bronchoscopy should combine different types of simulators to effectively train all relevant cognitive and psychomotor skills. Technical limitations and disagreements among experts about the level of competency required in FB need to be resolved before implementing the VR simulator in training and assessment.