Impact of structured curriculum with simulation on bronchoscopy.

BACKGROUND AND OBJECTIVE: Simulation enhances a physician's competency in procedural skills by accelerating ascent of the learning curve. Training programmes are moving away from the Halstedian model of 'see one, do one, teach one', also referred as medical apprenticeship. We aimed to determine if a 3-month structured bronchoscopy curriculum that incorporated simulator training could improve bronchoscopy competency among pulmonary medicine trainees. METHODS: We prospectively recruited trainees from hospitals with accredited pulmonary medicine programmes. Trainees from hospitals (A, B and C) were assigned to control group (CG) where they received training by traditional apprenticeship while trainees from hospital D were assigned to intervention group (IG) where they underwent 3-month structured curriculum that incorporated training with the bronchoscopy simulator. Two patient bronchoscopy procedures per trainee were recorded on video and scored independently by two expert bronchoscopists using the modified Bronchoscopy Skills and Tasks Assessment Tool (BSTAT) forms. A 25 multiple choice questions (MCQ) test was administered to all participants at the end of 3 months. RESULTS: Eighteen trainees participated; 10 in CG and eight in IG with equal female:male ratio. Competency assessed by modified BSTAT and MCQ tests was variable and not driven by volume as IG performed fewer patient bronchoscopies but demonstrated better BSTAT, airway anaesthesia and MCQ scores. Bronchoscopy simulator training was the only factor that correlated with better BSTAT (r = 0.80), MCQ (r = 0.85) and airway anaesthesia scores (r = 0.83), and accelerated the learning curve of IG trainees. CONCLUSION: An intensive 3-month structured bronchoscopy curriculum that incorporated simulator training led to improved cognitive and technical skill performance as compared with apprenticeship training.

A systematic review and meta-analysis of the clinical benefits and adverse reactions of anti-fibrotics in non-IPF progressive fibrosing ILD.

BACKGROUND: Anti-fibrotics can reduce restrictive impairment in idiopathic pulmonary fibrosis (IPF). However, its effectiveness in non-IPF progressive fibrosing interstitial lung disease (non-IPF PF-ILD) remains uncertain. OBJECTIVE: We assess the efficacy and safety of anti-fibrotics pirfenidone and nintedanib versus placebo among non-IPF PF-ILD adult patients. METHODS: Meta-analysis was performed using PubMed, SCOPUS, and Cochrane databases to identify randomized controlled trials (RCTs). At respective centers, non-IPF PF-ILD was defined as clinical and radiological findings inconsistent with IPF and greater than 5 % forced vital capacity (FVC) decline, worsening radiological fibrosis or respiratory symptoms. RESULTS: Among seven RCTs involving 1,816 non-IPF PF-ILD patients, anti-fibrotics significantly reduced decline in FVC from baseline in milliliters (MD -66.80milliliters; P < 0.01) and percent predicted (MD -1.80 %; P < 0.01) compared to placebo. However, severity of FVC decline was less than 10 % (P = 0.33) in both groups. No significant difference in the decline of 6MWD from baseline in meters (P = 0.19) while on anti-fibrotics, although those on pirfenidone had less decline in 6MWD (MD -25.12 m; P < 0.01) versus placebo. The rates of all-cause mortality (P = 0.34), all-cause hospitalization (P = 0.44), and hospitalization for respiratory etiology (P = 0.06) were comparable in both groups. Adverse events of nausea/vomiting (54.2 % vs. 20.3 %; P < 0.01), diarrhea (65.2 % vs. 27.6 %; P = 0.02), anorexia/weight loss (23.0 % vs. 7.7 %; P < 0.01), neurological disorders (20.8 % vs. 12.6 %; P < 0.01), and events requiring therapy discontinuation were higher (18.4 % vs. 9.9 %; P < 0.01) in the anti-fibrotic group. Other adverse events of skin (P = 0.18) and respiratory disorders (P = 0.20) were equal. CONCLUSION: The advent of anti-fibrotics offers alternative treatment to reduce lung function decline.

Integrating augmented reality technology in education: vector personal computer augmented reality.

Background: Educators often face difficulties in explaining abstract concepts such as vectors. During the ongoing coronavirus disease 2019 (COVID-19) pandemic, fully online classes have also caused additional challenges to using conventional teaching methods. To explain a vector concept of more than 2 dimensions, visualization becomes a problem. Although Microsoft PowerPoint can integrate animation, the illustration is still in 2-dimensions. Augmented reality (AR) technology is recommended to aid educators and students in teaching-learning vectors, namely via a vector personal computer augmented reality system (VPCAR), to fulfil the demand for tools to support the learning and teaching of vectors. Methods: A PC learning module for vectors was developed in a 3-dimensional coordinate system by using AR technology. Purposive sampling was applied to get feedback from educators and students in Malaysia through an online survey. The supportiveness of using VPCAR based on six items (attractiveness, easiness, visualization, conceptual understanding, inspiration and helpfulness) was recorded on 5-points Likert-type scales. Findings are presented descriptively and graphically. Results: Surprisingly, both students and educators adapted to the new technology easily and provided significant positive feedback that showed a left-skewed and J-shaped distribution for each measurement item, respectively. The distributions were proven significantly different among the students and educators, where supportive level result of educators was higher than students. This study introduced a PC learning module other than mobile apps as students mostly use laptops to attend online class and educators also engage other IT tools in their teaching. Conclusions: Based on these findings, VPCAR provides a good prospect in supporting educators and students during their online teaching-learning process. However, the findings may not be generalizable to all students and educators in Malaysia as purposive sampling was applied. Further studies may focus on government-funded schools using the newly developed VPCAR system, which is the novelty of this study.