A Training Tool Is Developed for Rigid Bronchoscopy

A tool developed to assess the competency for performing rigid bronchoscopy is earning a place in clinical training.

A team of pulmonologists from Duke Health and the University of California at Irvine created the Rigid Bronchoscopy Tool for Assessment of Skills and Competency (RIGID-TASC) to assess the skills and improve the training of interventional pulmonary fellows.

“Experts differ in their technique of performing rigid bronchoscopy,” says Kamran Mahmood, MD, a Duke pulmonologist.

This difference, Mahmood says, created confusion and often resulted in conflicting feedback to trainees. The new tool can be used to provide consistent, yet objective feedback to the learner. Mahmood was the lead author of a study published in the April 1, 2016, issue of Annals of the American Thoracic Society that described the development and validation of the RIGID-TASC checklist.

To assess the validity and interobserver reliability of RIGID-TASC, 30 volunteer physicians from 2 medical centers were selected in 3 categories:

• 10 novices at rigid bronchoscopy (performed ≥ 50 flexible, but no rigid, bronchoscopies)
• 10 operators with intermediate experience (performed 5-20 rigid bronchoscopies)
• 10 experts (performed ≥ 100 rigid bronchoscopies)

Participants included pulmonary and critical care fellows, interventional pulmonology fellows, and faculty interventional pulmonologists. Each participant performed rigid bronchoscopic intubation and navigation on a manikin.

Independently scored by 2 examiners using RIGID-TASC, the results demonstrated that the tool could objectively score and classify operators as novices, intermediates, or experts in basic rigid bronchoscopy.

Since the publication of the study, medical centers at Johns Hopkins, Emory University, Virginia Commonwealth University School of Medicine, and Lahey Hospital & Medical Center—in addition to Duke—have implemented the RIGID-TASC into interventional pulmonology training.

Although use of rigid bronchoscopy declined for several years following the introduction of the flexible bronchoscope, the procedure is experiencing a resurgence of interest for several therapeutic indications.

Rigid bronchoscopy is commonly performed to resect tumors from main airways, and it often uses various ablation modalities, such as laser and electrocautery. It is used to place airway stents, treat complex airway stenosis, and remove foreign bodies. Most patients undergoing these treatments are critically ill or have compromised respiratory status.

“Interest in this modality has increased, and we are doing a lot more rigid bronchoscopies,” says Mahmood. “More and more pulmonologists and fellows are expressing interest in learning this procedure.”

Members of the team that produced the RIGID-TASC study included Kamran Mahmood, MD, Momen M. Wahidi, MD, Scott L. Schofer, MD, and Kathleen Coles, RT, all from the Duke Division of Pulmonary, Allergy and Critical Care Medicine. Mohsen Davoudi, MD, and Kathryn E. Osann are from the Division of Pulmonary and Critical Care Medicine at the University of California at Irvine. Another author, Ellen E. Volker, MD, was associated with Duke at the time of the study.