Pilot Study of Web-Based Bronchoscopy Education Using the Essential Bronchoscopist© in Developing Countries (Mozambique and Mauritania)

Bronchoscopy training in developing countries is hampered by the high cost of textbooks, the scarcity of printed peer-reviewed literature and the prohibitive cost of travel to international meetings. A pilot study was therefore performed to record opinions regarding the contents, usefulness and relevance of the EB among physician learners with little or no bronchoscopy exposure, working in 2 very different developing nations (Mozambique and Mauritania) in which bronchoscopy training was provided as part of a project grant from the World Bronchology Foundation. In Mauritania, training was at the Nouâdhibou Regional Hospital, serving more than 300,000 people. Teaching was provided in French to 3 primary care specialists with little or no experience in flexible bronchoscopy and 2 general surgeons without previous experience in bronchoscopy. In Mozambique, training was at the 1,500-bed Maputo Central Hospital, a tertiary care facility serving 17 million persons. Teaching was provided in Portuguese and Spanish to 4 pulmonologists with various levels of experience in bronchoscopy, and 1 pediatrician and 2 anesthesiologists with minimal experience in bronchoscopy. In each hospital, the EB was administered using internet access and CD-ROM for 2 hours each day with the help of a multilingual instructor (S.Q.). Participants were also asked to individually study the EB for at least 1 additional hour each day. In addition to bronchoscopy skill acquisition using inanimate models, didactic lectures and hands-on patient care, participants completed the EB in their maternal language and in English so as to obtain passing scores ( 1 70% correct answers) on all post-tests. At the end of a 7-day training session, participants completed an anonymous, 9-item questionnaire addressing the usefulness (3 questions), content (3 questions) and possible learning advantages (3 questions) of the EB compared to other modes of learning to which they had been exposed. All 12 participants (100%) found the EB useful and said that they would continue to use it as a source for learning. Seventy-five percent preferred using the interactive internet or CD version of the EB to a textbook. Ten of the 12 participants (83%) stated that the material contained in the EB was not readily found in textbooks of bronchoscopy. Seventy-five percent said that contents were presented clearly, whereas 25% found the presentation partially confusing. Eighty-four percent found the contents relevant, but 2 participants (17%) said that the EB had little relation with their daily practice, most likely because of a lack of available technology in these countries. Indeed, many of the question-answer sets of later modules pertain to therapeutic bronchoscopic interventions. Seventy-five percent found the contents easier to remember using the interactive question-answer style than similar information presented in textbook style, and two thirds (66%) of all participants said that learning using the EB was less boring than reading a textbook. Ten of the 12 participants (83%) preferred using the EB with an instructor rather than alone.