Web Bronchoscopy

The Web site “Web-Based Bronchoscopy Simulator” located at www.thoracicanesthesia.com was created by Drs. Kanellakos, Dugas, and Slinger from the University of Toronto. This is a very interesting and informative Web site whose most outstanding feature is the actual bronchoscopic simulation and bronchial anatomy test, all free of charge. However, the Web site has much more information than just the simulation and test. The initial part of the Web site is organized into sections by subject or dates – under these sections there are article abstracts and lectures about multiple topics in thoracic anesthesia. Of note, this is organized in a cross-referenced system, so that the same article may appear under a descriptor such as “Analgesia” as well as under a date such as “August 2008.” A review of the articles showed a great selection and breadth of thoracic topics of interest to anesthesiologists, ranging from older classic articles to the most recent journal publications. These articles and lectures can form the platform for robust discussions with colleagues or educational sessions with fellows and residents caring for complex thoracic surgical patients. The highlight of this Web site is located as one scrolls to the bottom of the site – the bronchoscopy simulator. However, to access the simulator, one must first complete a bronchial anatomy quiz, which the reviewers found challenging. Once the quiz is complete, with appropriate answers given for incorrect responses, one can move on to the bronchoscopy simulator. Although anxiety provoking, the use of a pre-test of bronchial anatomical knowledge to compare to a post-test of that knowledge is very useful for determining the effectiveness of this activity and individually to determine how much one has actually learned. Of note, the bronchial anatomy quiz is also difficult, as it is static with photos only, in distinction to the bronchial simulator, which is in motion. The figure below shows a sample bronchial anatomy quiz question.FigureOnce one enters the bronchoscopy simulator, multiple choices are given for using the simulator and how to drive the simulated bronchoscope. The guide diagram (shown in the column to the right) illustrates the location in the bronchial tree that one is viewing at any particular time. From there, one can choose to use the simulator with or without labels (great for teaching) and in various formats. The steering was useful and accurate as were the explanatory icons. Although not quite as realistic as using an actual bronchoscope, the ability to appear to move in three dimensions allowed one to learn the distal anatomy within the context of how one arrived at a particular location. Once done with the simulator, one is directed to take the post simulator test. Afterward, the program provides a useful breakdown about an individual's score relative to others who have used the Web site. The figure below shows a sample bronchoscopy anatomical view with and without labels.FigureWe have only very minor criticisms or suggestions for this site. The program teaches much more than the anesthesiologist needs to know to safely conduct a thoracic anesthetic or properly position a double lumen endotracheal tube/bronchial blocker. This is not a real problem but may be disconcerting to established practioners who are not facile at identifying the subsegmental anatomy of the bronchial tree. Since much of a practioner's time is spent properly achieving lung separation, it might be useful to include a video of how to place a double lumen tube or bronchial blocker to accompany the simulator. There are a few minor improvements that could be made, such as being able to enlarge the simulator to the size of the entire computer screen and making sure that all of the descriptions are easy to read. Overall, this is a wonderful learning and teaching tool. It is useful for those in practice, fellows, residents, and students alike. As educators, it is extraordinary to be able to teach bronchoscopic anatomy and landmarks in the OR in a relaxed manner that is conducive to discussion, instead of while struggling to properly position a double lumen endotracheal tube! Katherine Grichnik, MD Professor of Anesthesia Duke University Durham, NC [email protected] Susan Martinelli, MD Assistant Professor of Anesthesia University of North Carolina Chapel Hill, NC [email protected]

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