Skill with a fibreoptic endoscope is an essential element of advanced airway management. Over the years, several endoscopy trainers have been developed and used for training fibreoptic endoscopy.1 ORSIM (Inventive Medical Limited, London, UK) is a high fidelity simulator which can be run using a laptop computer. It offers a complete virtual airway with high-quality three-dimensional graphics in conjunction with a replica bronchoscope (Fig. 1a). Dexter Endoscopic Dexterity Trainer (Replicant Ltd. Wellington, New Zealand) is a modular, nonanatomical endoscopic dexterity training system. It consists of a series of channels, pods and images which help in developing the skills required for manipulation of the fibreoptic bronchoscope (Fig. 1b). The Oxford Fibreoptic Teaching Box (Pharmabotics Ltd. Hampshire, UK) consists of a cylindrical box which has multiple plates, each drilled with a number of holes. It allows the operator to develop spatial orientation for fibreoptic scope manipulation (Fig. 1c). In this study, participants in an airway management course compared the usefulness of these three fibreoptic bronchoscopy training devices.
All participants attending two airway management courses at University Hospital, Coventry (March 2013 and October 2013) were invited to participate. The regional research ethics committee waived the need for formal ethical approval as this study was conducted on manikins and participation of participants was voluntary.
In the workshop, an instructor demonstrated the use of a fibreoptic scope on all three models (ORSIM, Dexter Trainer and Oxford Box). The participants then practised endoscopy on each of the training models in a random order. At the end of the session, participants were asked to complete a questionnaire with regard to the usefulness of each training model (using a Likert scale of 1 = strongly disagree to 5 = strongly agree), in four areas: understanding airway anatomy; improving psychomotor skills; handling the scope to obtain a central view; and reduction in tissue impact. The differences in scores between devices were tested using the Wilcoxon signed rank-sum test with Bonferroni correction, as the scores were not normally distributed.
In total, 93 participants completed the questionnaire. The median (interquartile range) score for each of the four domains for the three models is shown in Table 1. The ORSIM had higher scores in all four domains compared with both the Dexter Trainer and Oxford Box (P < 0.01 for all comparisons). The Oxford box received the lowest score for helping participants understand airway anatomy. Following hands-on experience with all three models, 76 participants (81.7%) felt that they would prefer to train on the ORSIM to improve their skills in fibreoptic endoscopy.
A static model such as the Dexter Trainer2,3 and Oxford Box4 may help in improving fibreoptic endoscopic skill to a certain extent, but a dynamic bronchoscopy simulator (ORSIM) offers an additional advantage. The virtual environment enhances the ability of the operator to interact and improvise with the changing scenario, which is the dynamic component.5 The participants agreed that the ORSIM improved hand-eye coordination, which is an essential component of fibreoptic endoscopy training. This study demonstrated that when fibreoptic endoscopic training is provided using these models, the advantages of the dynamic component become more evident.
Acknowledgements relating to this article
Assistance with the letter: the authors would like to thank Richard Crossman (Research Fellow, Division of Health Sciences, Warwick Medical School) for his help with statistical analysis.
Financial support and sponsorship: none.
Conflicts of interest: none.
1. Raveendra US. Teaching and training in fibreoptic bronchoscope-guided endotracheal intubation. Indian J Anaesth
2. Agro F, Sena F, Lobo E, et al. The Dexter Endoscopic Dexterity Trainer improves fibreoptic bronchoscopy skills: preliminary observations. Can J Anesth
3. Marsland C, Larsen P, Segal R, et al. Proficient manipulation of fibreoptic bronchoscope to carina by novices on first clinical attempt after specialized bench practice. Br J Anaesth
4. Martin KM, Larsen PD, Segal R, Marsland CP. Effective non-anatomical endoscopy training produces clinical airway endoscopy proficiency. Anesth Analg
5. Boet S, Bould MD, Schaeffer R, et al. Learning fibreoptic intubation with a virtual computer program transfers to ’hands on’ improvement. Eur J Anaesthesiol