Assessment of bronchoscopy training and competency: a narrative review

Background and Objective: There have been efforts to define appropriate training standards for bronchoscopy skill acquisition over the decades. Towards the end of the 20^th century, the prevailing paradigm focused on numbers-based standards for trainee skill acquisition. Multiple societies recommended set procedural numbers for trainees and practitioners for verification of competency in bronchoscopy. As understanding of procedural training has evolved, educators have concluded that a numbers-based approach is insufficient for training as well as for assessment of competency. Educators have realized that there is variability across performers and solely relying on numbers of procedures performed is inadequate. Hence, focus has shifted towards structured curricula that can incorporate multiple educational modalities to supplement technical bronchoscopic skills acquisition. These modalities include educational modules, simulation training and assessment tools. The primary objective of the narrative review is to detail the history and evolution of flexible bronchoscopy training strategies. In this review, we will aim to discuss the educational theory that underpins these strategies. While the training recommendations have been reviewed elsewhere in the published literature, the discussion of the educational theory has been limited. We aim to delve into the educational theory that supports these training strategies. Methods: Literature search in the PubMed and MEDLINE databases was performed. Our literature search included the time-period from January 1, 1964 to May 1, 2023. Search was restricted to articles available in standard English. Key Content and Findings: This narrative review will contain historical recommendations for standardization of bronchoscopic training and how they have changed over time. We will review the current training standards and the educational theory that underpins them. The findings support focusing on bronchoscopic competence metrics rather than a solely number-based approach. Conclusions: Within the modern curricula, learners have access to training and assessment tools which have been validated for bronchoscopic education. These tools include educational modules, low and high-fidelity simulation models, and validated assessment tools. Training programs need to work to implement these tools and techniques in their educational framework to provide learners with the most optimal learning processes in bronchoscopy education.