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Using simulation to teach patient‐centered ultrasound‐guided FNA skills

Fine-needle aspiration (FNA) biopsy procedures have a deceptive simplicity. The gauge of the needle, the number of passes, and what suffices for adequacy all may vary with the specific situation. The challenge of performing a biopsy comes from knowing which technique or criteria to use for a given scenario. Our explicit knowledge only hints at the deeper wisdom necessary for approaching novel cases. The art of medicine is the process of finding answers to questions of technique in unfamiliar situations. The style in which we step into unfamiliar territory is relevant to both trainees and seasoned interventional cytopathologists. For trainees, every case is novel. A trainee needs to “learn how to learn.” The teaching cytopathologist must both impart this wisdom and use it. He or she must be ready for anything. He or she must balance the humble limits of experience with a tolerance for risk while learning new things. This is a reason why physicians “practice.” In the theme of deceptive simplicity, we propose a simple question that deserves attention: how do we physically position our patient and ourselves when performing an ultrasound-guided FNA biopsy? Every patient has a different body and physiology. Identical lesions in different patients may require radically different approaches. A patient with shoulder osteoarthritis might not be able to assume a position that is easy for many other patients. A patient with heart failure might not tolerate lying in a supine position. Managing these idiosyncrasies is an important part of interventional cytopathology. Because we practice other skills in cytopathology, such as making smears, we propose a simple solution: practice optimal physical positioning of the patient and the interventionalist physician.