From Prototype to National Standard: Implementing a Governance Framework for Bronchoscopy Simulation Training

Background Simulation-based education improves procedural competence and patient safety; however, most programs remain locally implemented and are rarely integrated into national training systems. Reports describing sustainable national-scale implementation remain limited. We describe a national governance reform that embedded bronchoscopy simulation within postgraduate medical education at the national level. Methods We conducted a national implementation study evaluating the integration of bronchoscopy simulation training into postgraduate medical education. Bronchoscopy served as the index procedure within a broader reform of procedural training. The intervention combined mastery learning and deliberate practice with objective structured assessment. Governance mechanisms included the development of nine national Standard Operating Procedures (SOPs), instructor certification through a train-the-trainer pathway, establishment of a coordinated network of simulation centers, external quality assurance processes, and integration into postgraduate certification requirements. Implementation was interpreted using the Consolidated Framework for Implementation Research (CFIR) and the RE-AIM framework. Results The national program trained 402 physicians, supported by 85 nationally certified instructors. A total of 184 structured training cycles were delivered, representing 5,999 instructional hours. Bronchoscopy training was implemented as a specialty-specific component of the national simulation program through a structured, multi-stage scale-up process. The training involved 186 enrolled physicians, of whom 185 completed the program. Post-course evaluation demonstrated high acceptability and perceived educational value: 89.5% of participants rated the training as highly relevant to clinical practice, and 98.5% reported increased procedural confidence. Faculty evaluations indicated strong agreement regarding instructional standardization and clarity of assessment procedures. In addition, 46 instructors were certified for the bronchoscopy training component, supporting delivery across a multi-centre simulation network. Following national evaluation, bronchoscopy simulation became a mandatory training requirement in 2024 for physicians specializing in pulmonary diseases. Over €75 million in EU structural funding supported the development of a national network of simulation centers and training capacity for endoscopic procedures. Conclusions National-scale integration of simulation depends less on technology than on governance architecture, standardized faculty development, and alignment with regulatory frameworks. When educational theory is integrated with implementation science and patient-safety priorities, simulation can transition from local innovation to a sustainable national training standard.