P184 Identifying learning strategies used by respiratory trainees in bronchoscopy

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Introduction and Objectives

Medical bronchoscopy is a key skill for respiratory physicians taking years to achieve competency. The majority of trainees learn traditionally by one-to-one mentorship. However, introduction of the European Working Time Directive and increase in numbers of trainees has led to a breakdown in the mentorship model and reduced opportunity to attend procedural lists. In 2009, Du Rand and Lewis presented results of a national survey of training in Bronchoscopy. “Learning curves” of average number of procedures required to become competent in different aspects of sampling in bronchoscopy were presented, but no information was gathered on different approaches to learning or factors affecting these curves. Indeed, there have been no studies examining “how” trainees learn in bronchoscopy. This study aimed to identify learning strategies currently being used by respiratory trainees in bronchoscopy and any helpful or unhelpful factors in this learning strategy.


A qualitative study in two parts was conducted between April and June 2011. Firstly, a questionnaire to all respiratory trainees in the Northern Deanery. Thematic analysis was used to identify core themes and design the format for a subsequent focus group. The focus group was transcribed in full and two independent evaluators identified themes from the raw data. Triangulation was sought through a separate questionnaire to trainers. Validation of results was provided through local presentation of results.


19 trainees and seven consultants completed questionnaires and five trainees took part in the focus group. Abstract P184 table 1 summarises themes identified. Few trainees had an explicit learning plan, however, trainees and trainers readily identified key steps involved in the primary approach of “learning from experience”. Furthermore, many participants identified similar helpful and unhelpful factors within their own learning, their trainers' behaviour and the training environment. Many of these findings are supported by established learning theory and procedural-based learning (Kolb, 1984, Thuraisingam et al, 2006).


Experience of the procedure is the key learning approach used by trainees in bronchoscopy. There are core steps within this that trainees and trainers can utilise to maximise learning. This is particularly important at the current time as training opportunities in bronchoscopy are reduced.

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