CHEST Guidelines-Linear-Endobronchial-Ultrasound-Learning-Curve

Linear-Endobronchial-Ultrasound-Learning-Curve_che

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In a recent article published in CHEST, Wahidi et al. reported that pulmonary trainees achieved competence in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) after only 13 procedures. This finding underscores the effectiveness of standardized EBUS-TBNA training, including expert-led lectures and the use of simulators. Andrew R.L. Medford, in his correspondence, suggests further exploration into the individual contributions of lectures and simulators, which could benefit curriculum development.<br /><br />Medford highlights the complexity of determining the exact number of procedures required for achieving independent competence, noting that no universal standard exists for proficiency in EBUS-TBNA. While independent EBUS-TBNA performance revolves around the ability to sample lymph nodes effectively, achieving consistent diagnostic sensitivity might take much longer, with some studies suggesting improvements post-100 procedures. The significance of these findings in defining "competence" remains debatable.<br /><br />Additionally, Medford points out that several variables may impact the EBUS-TBNA learning curve. The study by Wahidi et al. showed a mean lymph node size of 1.99 cm, with most procedures focusing on larger nodes. In contrast, the learning curve may lengthen when dealing with smaller nodes, as in cancer staging procedures. Rapid on-site evaluation for cytology (ROSE) might further shorten learning durations by providing immediate feedback, necessitating comparative studies with and without its use.<br /><br />Medford concludes by emphasizing the need for more research to establish an agreed-upon standard for the EBUS-TBNA learning curve that considers additional factors such as pre-existing skills, procedure indications, pathology processes, and educational methods. Understanding these elements will aid in creating a comprehensive training framework for EBUS-TBNA.

Keywords

EBUS-TBNA

pulmonary trainees

competence

standardized training

lectures

simulators

learning curve

diagnostic sensitivity

ROSE

training framework