Artificial Intelligence-Guided Bronchoscopy is Superior to Human Expert Instruction for the Performance of Critical-Care Physicians: A Randomized Controlled Trial
Bibliographic record
Abstract
OBJECTIVES: Bronchoscopy in the mechanically ventilated patient is an important skill for critical-care physicians. However, training opportunity is heterogenous and limited by infrequent caseload or inadequate instructor feedback for satisfactory competencies. A new artificial intelligence (AI) navigational system using augmented reality - the Ambu Broncho Simulator - can guide bronchoscopy training. Is training with the AI system comparable to bedside, expert tutor instruction in improving bronchoscopy performance? DESIGN: A nonblinded, parallel group randomized controlled trial was conducted. SETTING: The study was conducted in a simulated setting at an academic university hospital. SUBJECTS: Critical-care physicians were invited to take part in the study. INTERVENTIONS: Forty participants received 30 minutes of bronchoscopy training, either guided by AI only (artificial intelligence group [AIG]) or by expert tutor feedback (expert tutor group [ETG]). All participants performed a final full navigation bronchoscopy performance test and completed a cognitive load questionnaire, the NASA Task Load Index . MEASUREMENTS AND MAIN RESULTS: Mean intersegmental time (MIT = PT/DC), diagnostic completeness (DC), procedure time (PT), structured progress (SP), and number of segments revisited (SR) were measured. The primary outcome measure assessed was MIT, a measure of bronchoscopic performance efficiency. The secondary outcome measures were DC, PT, SP, and SR. Nineteen participants were randomized to the AIG and 21 participants to the ETG. MIT, PT, and SR were significantly better in the AIG compared to the ETG (median difference, p ): MIT (-7.9 s, 0.027), PT (-77 s, 0.022), SR (-7 segments, 0.019); all showing moderate effect sizes (0.35, 0.36, and 0.37, respectively) as per Cohen's classification.There was no significant difference between the groups for all other final test measures. CONCLUSIONS: Training using an AI system resulted in faster and more efficient bronchoscopy performance by critical-care physicians when compared to expert human tutor instruction. This could change the future of bronchoscopy training in critical care and warrants validation in patients through clinical studies.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".