Digital twin-based bronchoscopy simulator improves training performance and skill retention of novices: a randomised controlled study

Clinical Snapshot

Key Findings

• P Value: p<0.001 for both diagnostic completeness and structured progress in test 2

• Effect Size: Anatomic-variety group: 2.5 more segments completed, 9 more correct progressions vs anatomic-uniformity group

• Primary Outcome: Diagnostic completeness and structured progress in test 2 (novel CT-derived model)

• Nnt Or Sensitivity: Not calculable from provided data - continuous outcomes reported as mean differences

• Confidence Interval: Not reported

Clinical Application

Requires digital twin simulation technology and multiple CT-derived bronchial models - feasible in well-resourced training centres Highly relevant to Australian respiratory medicine training programs; aligns with RACGP simulation-based learning recommendations and could enhance procedural competency before patient exposure Respiratory medicine trainees, medical students, and healthcare professionals learning bronchoscopy

Abstract

RATIONALE: Conventional bronchoscopy training often does not ensure lasting skill retention or adaptability to different anatomies, limiting real-world impact. This study used a digital-twin bronchoscopy simulator with various CT-derived bronchial tree models to better train novices. OBJECTIVES: To explore training with various anatomically diverse bronchial tree models in novices' bronchoscopy performance. METHODS: 60 bronchoscopy-naive participants were randomly assigned to three groups (n=20 each): control (written instruction only), anatomic-uniformity (trained on one standard bronchial model) and anatomic-variety (trained on multiple patient-derived bronchial models). All participants performed two tests: test 1 on a standard model and test 2 on a new CT-derived model. Both tests were repeated 3 months later to assess skill retention. The primary comparison was between the anatomic-variety and anatomic-uniformity groups. MEASUREMENTS AND MAIN RESULTS: 60 participants completed tests 1 and 2. 55 returned at 3 months. In test 1, there were no significant differences between the anatomic-variety and anatomic-uniformity groups in diagnostic completeness (DC, 0 segments, p=0.576), structured progress (SP, 1 correct progression, p=0.091) and procedure time (31 s, p=0.831). In test 2, the anatomic-variety group had significantly higher DC (2.5 segments, p<0.001) and SP (9 progression, p<0.001) than the anatomic-uniformity group. At 3 months, the anatomic-variety group retained superior DC and SP scores in both tests despite slight declines. CONCLUSIONS: Training with diverse anatomical models significantly enhanced bronchoscopy performance compared with repetitive practice on a single standardised model with partially maintained learning gains at 3 months.

References

1. 1.Deng, M., Li, F., Tang, F., Chen, W., Wang, F., Tang, C. L., Tong, R., Yang, Z., Xu, W., Zhang, N., Xia, Y., Li, S., Herth, F. J. F., & Hou, G. (2026). Digital twin-based bronchoscopy simulator improves training performance and skill retention of novices: a randomised controlled study. Thorax. https://doi.org/10.1136/thorax-2025-223147