Use of the Ontario Bronchoscopy Assessment Tool to Enhance Post Procedural Feedback for Pulmonary Fellows

RATIONALE For many pulmonary fellows, bronchoscopy is the most common procedure performed during fellowship. This vast number of bronchoscopies creates a unique opportunity for frequent assessment of skills, and continual feedback. Despite bronchoscopy being a skill paramount to pulmonary medicine, many fellowship programs lack a process for standardized assessment of skills over time. Additionally, a common concern within graduate medical education, is the desire for more frequent verbal feedback. The Ontario Bronchoscopy Assessment Tool (OBAT) has previously been validated to assess trainee competence with planning and performing bronchoscopy. We became interested in using the OBAT to objectively assess fellow progression in performing bronchoscopy, as well as enhance the satisfaction with feedback surrounding this procedure. METHODS From July 2019 through August 2020 attendings were asked to fill out the OBAT with the fellow after each fellow-performed bronchoscopy. Weekly reminders were sent via text messaging to all attendings within the division. Scores across the 19 categories in the OBAT were compared from the beginning and end of the trail period for two different fellowship classes (first and second years as of July 2019). Following the end of the trial period, surveys were sent to attendings and fellows assessing their satisfaction using the tool. RESULTS There was an average of 23.3 fellow performed bronchoscopies per month with an accompanying monthly OBAT completion rate of 29.6%. The junior fellowship class displayed a larger improvement in average scores. The three most significant improvements were appropriate administration of sedation, inspection in an orderly manner, and assessing for post procedural complications, with a difference of 3, 2.3, and 3 points (5-point scale) respectively. 88% of fellows felt the OBAT was a useful way to receive feedback and the same number stated they preferred the OBAT over traditional, impromptu feedback. 62% of fellows felt feedback happened more frequently because of the OBAT. 66% of attendings felt the tool was helpful way of giving feedback. Most fellows and attendings prefer to continue to use the OBAT in the future. CONCLUSIONS We found the OBAT most beneficial for prompting detailed feedback following a bronchoscopy. Nearly all fellows preferred to receive feedback using the OBAT compared to spontaneous feedback which, at times, was felt to be lacking in substance. We found monitoring individual progress difficult due to low OBAT completion rate. For future utilization, staff education and frequent reinforcement of the goals of the tool may help improve completion rates.

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