Building competency in navigation bronchoscopy: Development and evaluation of a structured training programme

BACKGROUND: Cone-beam CT-guided navigation bronchoscopy (CBCT-NB) is a minimally invasive technique for diagnosing pulmonary nodules combining endoscopic navigation with real-time 3D imaging. The procedure requires advanced bronchoscopic skills and interpretation of multiple imaging modalities. Despite evidence that simulation-based education enhances procedural safety and performance, no standardised training programmes for CBCT-NB have yet been established. This study describes the development and evaluation of a structured training programme for pulmonologists new to CBCT-NB. METHODS: A multidisciplinary expert panel developed a stepwise CBCT-NB training programme comprising online theoretical e-learning, live case observation at an expert centre, a structured one-day hands-on simulation session, and on-site supervision during the initial clinical procedures. Pulmonologists from Dutch hospitals preparing to implement CBCT-NB were enrolled. Participants' expectations, perceived learning needs, and post-training experiences were explored through semi-structured interviews and analysed using thematic analysis. RESULTS: Nine pulmonologists from five hospitals participated. Participants expressed a strong need for structured, practical instructions, particularly regarding procedural workflow, multimodal image interpretation, equipment handling, and use of augmented fluoroscopy software. Following completion of the programme, all reported increased self-confidence and improved perceived competency. Hands-on simulation was consistently identified as a key component for developing technical and cognitive skills and was considered essential preparation before independent clinical practice. CONCLUSION: The structured multimodal CBCT-NB training programme facilitates confidence and addresses learner-identified competency needs among novice navigation bronchoscopists. The findings offer practical guidance for the structured implementation and training of novel medical technological interventions. Future research should evaluate long-term skill retention, objective competency outcomes, and clinical effectiveness.