Time between endobronchial ultrasound needle passes as a metric to monitor progress of trainees

ABSTRACT

Background

Methods to assess and track progress of new endobronchial ultrasound (EBUS) operators and trainees is desirable to ensure training goals and procedural competence are achieved. Relying on the diagnostic yield or on question-based assessments alone is not sufficient. This study examined the longitudinal change in times taken between needle passes (needle pass time; NPT) during EBUS lymph node sampling as a metric to monitor progress.

Research Design and methods

:The EBUS database of a tertiary hospital was accessed to extract data on the first 50 EBUS procedures for three trainees. The NPT was derived using PACS images that are stored to document every needle pass during an EBUS procedure and an average NPT was calculated.

Results

Between the three trainees, 157 procedures were carried out within the study period with 302 nodal stations sampled. The mean NPT (n = 204 stations) was 2:49 ± 0:49 mins. The mean node short axis diameter was 15.5 ± 8.7 mm. There was a negative correlation between node size and time per pass (r − 0.146, p = 0.045).

The average NPT showed a negative correlation with procedure order through the first 50 procedures. Less variation between procedures was noted for the three trainees from the 30^th procedure onward. On multivariate regression, NPT was significantly associated with procedure order regardless of station sampled or lymph node diameter.

Conclusion

NPT is novel, easy, and robust metric that can potentially help ensure EBUS trainees are advancing in a given training program.

KEYWORDS:

• Endobronchial ultrasonography
• transbronchial needle aspiration
• training

Funding

This paper was not funded.

Article highlights

• A practical real-life evaluation tool to monitor the training progress of new EBUS bronchoscopists is desirable

• The time spent between needle passes and between stations are feasible metrics to monitor during training in EBUS. Time between needle passes appears to be a more robust metric in detecting progress.

• Time between needle passes shows consistent improvement overtime between trainees, albeit with different rates and this is independent of the size or the station of the lymph node sampled.

Statement of ethics

This is part of ongoing audit registered at University Hospitals Plymouth (CA_2016-17-093). The data was collected from NHS patients as part of their standard care and is thus dedicated informed consent was not deemed necessary.

Acknowledgments

Data from this manuscript was presented in abstract form at the virtual Winter British Thoracic Society Meeting, February 2021.

Authors contribution

C. Daneshvar conceived the study. M. Hassan, H. McDill, W.E. Falconer, L. Taylor, T. Howell, J. Corcoran and C. Daneshvar collected study data. M. Hassan performed the statistics and drafted the manuscript. All authors reviewed and approved the final manuscript.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.