Simulation-Based Bronchoscopy Training (publication featuring Dexter® highlighted favourably in 2013 Mayo Clinic meta-analysis)

‘Inductive analysis to inform instructional design suggested that longer or more structured training is more effective, authentic clinical context adds value, and animal models and plastic part-task models may be superior to more costly virtual reality simulators.’

Kennedy CC, Maldonado F, Cook DA. Simulation-Based Bronchoscopy Training: Systematic Review and Meta-analysis. Chest 2013 Jul1; 144(1): 183-92

Marsland C, Hunter S, Larsen P. Simulation-based bronchoscopy training for anaesthetists: proficiency from a non-mastery workshop. Submitted for publication 2013.

Learning Bronchoscopy

Duration of distributed practice required by novices to achieve proficiency (96% within 4 hrs of practice) was demonstrated in a study published in the British Journal of Anesthesia in 2010.

Marsland CP, Larsen PD, Segal R, Hunter S et al. Proficient manipulation of fibreoptic bronchoscope to carina by novices on first clinical attempt after specialized bench practice. British Journal of Anaesthesia 2010 104;3:375-81

Rationale for bronchoscopy training on bench models prior to clinical exposure detailed in response to letter to the editor of the British Journal of Anaesthesia in 2010.

Marsland C, Larsen P. Competent in 2 hrs of training…too good to be true? (response to letter) British Journal of Anesthesia 2010;104:6:78

Bronchoscopic performance in the medium term reflects the level of skill achieved at initial training rather than the frequency of subsequent exposure to the technique. Abstract presented at Difficult Airway Society Meeting Cardiff 2012.

Marsland C, Larsen P, Hunter S. Driving a bronchoscope-initial skill level achieved rather than frequency of use predicts medium term performance. Abstract DAS Meeting 2012

Dexter in proximity to the operating theatre or ICU recommended as a means to develop endoscopic dexterity prior to patient contact published in Anaesthesia and Intensive Care in 2006.
Jones RW, Morris RW. Facilitating learning in the operating theatre and intensive care unit. Anaesthesia and Intensive Care 2006; 34: 758-764

Bronchoscopy Training Effectiveness

Dexter was more effective than another part-task trainer with trainees preferring it and practicing for longer. Clinical endoscopic effectiveness by novice endoscopists after Dexter training with 93% transference of bench proficiency to the clinical environment on first clinical attempt was published in Anesthesia and Analgesia in 2004

Martin KM, Larsen PD, Segal R, Marsland CP. Effective Non-Anatomical Endoscopy Training Produces Clinical Airway Endoscopy Proficiency. Anesth Analg 2004;99:938-44.

Improvement of bronchoscopy skills after training with Dexter was published in the Canadian Journal of Anesthesia in 2005.

Agro F, Sena F, Lobo E, et al. The Dexter Endoscopic Dexterity Trainer improves fibreoptic bronchoscopy skills: preliminary observations. Can J Anesth 2005 52;215-216.

Bronchoscopy Training Models.

The basic rationale for Dexter was published in the Journal of Clinical Anesthesia in 2002:

Marsland CP Robinson BJ, Chitty CH, Guy BJ. Acquisition and Maintenance of Endoscopic Skills: Developing an Endoscopic Dexterity Training System for Anesthesiologists. JCA 2002;14:615-619


1st Prize Scientific Exhibits International Anesthesia Research Society Honolulu 2000

Best Instructional Exhibit Post Graduate Assembly in Anesthesiology New York 2000

Best Awards New Zealand Institute of Design 2001