Combining a Low-Cost Bio-Simulator and Single Use or Disposable Bronchoscope: A Platform for Remote Training

Abstract
Introduction: The COVID-19 pandemic has resulted in a reconsideration of our traditional teaching modalities and develop newer, dynamic methods. Both high and low fidelity bronchoscopy simulators are costly. The objective was to assess whether a combination of a low-cost bio-simulator made of recyclable materials (ALFIETM Airway Low Fidelity including EBUS (endobronchial ultrasound)) and single use flexible bronchoscopy (SUFB) has the capability of differentiating novices from experts and the ability to train novices in bronchoscopy. Materials and Methods: Trainees were evaluated individually before and after training using a modified validated Bronchoscopy Skills and Tasks Assessment Tool (B-STAT) and SUFB. Results: 18 trainees were included (14 residents and 4 fellows). Pre-training assessment of scope handling differentiated novices from experienced bronchoscopists (p = 0.0025, 95% confidence intervals (CI) 3.12 - 12.17). Training of novices was associated with an improvement in scope handling and sampling (p = 0.0001, 95% CI 4.73 - 10.27). Conclusion: ALFIETM and SUFB have the potential to create a low-cost platform to teach bronchoscopy remotely.