From leadership research to district action: From prototype to national standard: a governance framework for scaling simulation-based bronchoscopy training

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Abstract Background Simulation-based education can improve procedural training, but national adoption depends on governance, scalability, quality assurance, and alignment with postgraduate certification requirements. This Advancing Simulation Practice report describes how bronchoscopy simulation developed from a pilot educational initiative into a mandatory national component of postgraduate pulmonary medicine training. Main body We present a practice-based implementation account of a national reform in procedural training, using bronchoscopy as the index procedure. Rather than testing an effectiveness hypothesis, we examine programme design, governance, scale-up, instructor development, quality assurance, and regulatory embedding. The Consolidated Framework for Implementation Research and the RE-AIM framework were used to structure reflection on implementation determinants and programme outcomes, rather than as prospectively applied measurement instruments. The national simulation programme trained 402 physicians across procedural specialties, supported by 85 nationally certified instructors, and delivered 184 structured training cycles comprising 5,999 instructional hours. The bronchoscopy component enrolled 186 pulmonary specialty trainees, of whom 185 completed the course; 46 instructors were certified to deliver bronchoscopy training. Post-course evaluations showed high perceived relevance and increased self-reported confidence, which are interpreted as acceptability and early implementation indicators rather than evidence of clinical competence. Following national evaluation, bronchoscopy simulation was incorporated in 2024 as a mandatory component of postgraduate specialisation training in pulmonary diseases. Scale-up was supported by national-level European Union structural funding for health workforce development and simulation infrastructure, including POWER project POWR.04.03.00-00-0291/16, in which bronchoscopy formed one component of broader endoscopic simulation capacity. Conclusion The main contribution of this programme was the governance pathway that enabled simulation to progress from local innovation to national training policy. Sustainable implementation depended on staged scale-up, explicit curriculum design, instructor certification, common standard operating procedures, external quality assurance, distributed simulation-centre capacity, and alignment with regulatory postgraduate training requirements. Future evaluation should examine clinical transfer, workplace performance, and patient-safety outcomes. Keywords: Bronchoscopy, Simulation-based education, Postgraduate medical education, Implementation science, Procedural training, Quality assurance

Study methods

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Limitations

Several limitations should be acknowledged. First, this is a practice-based implementation account rather than a controlled effectiveness study. Second, participant feedback was collected immediately after course completion and therefore captures acceptability, perceived relevance, and self-efficacy rather than competence, retention, workplace transfer, or patient outcomes. Third, the implementation occurred within a specific Polish postgraduate regulatory and funding context, which may limit direct transferability. Fourth, although SOPs and external audit supported fidelity, this report does not present independent psychometric validation of all assessment tools or longitudinal data linking simulation performance to clinical bronchoscopy outcomes. Fifth, because the evaluation was designed for implementation monitoring rather than comparative effectiveness testing, no inferential statistical analysis was undertaken.

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Select one recurring district decision. Publish the decision owner, evidence requirements, consultation process and appeal route; test the process on a bounded low-risk decision. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Track decision time, unresolved objections, documented reasons, appeals and access differences. Review whether the process changes who can participate and who carries the burden. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Michal Pirozynski; Jack Jakimowicz. From prototype to national standard: a governance framework for scaling simulation-based bronchoscopy training. Advances in Simulation (2026-06-08). https://doi.org/10.1186/s41077-026-00452-9

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.