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Presented by: Sero Andonian, MD, MSc, FRCSC, FACS
Authors: Mehdi Aloosh, Felix Couture, Nader Fahmy, Mostafa Elhilali, Sero Andonian
Affiliation: Division of Urology, McGill University, Montreal, Quebec, Canada
Written by: Renai Yoon, Department of Urology, University of California-Irvine at 35th World Congress of Endourology– September 12-16, 2017, Vancouver, Canada.
Vancouver, Canada (UroToday.com) Dr. Mehdi Aloosh, from McGill University, presented data that examined the use of the simulator to assess the competency of urology post-graduate trainees (PGTs). As an introduction to his presentation, Dr. Aloosh explained that flexible ureteroscopic lithotripsy is the gold standard for the management of most ureteral and renal stones and that simulators for this procedure may provide a safe environment and objective assessment of PGT competency.
For this study, Task 10 on the UroMentor simulator from Simbionix was used to assess competency in ureteroscopic stone extraction skill. Task 10 required each PGT to enter a bladder model using a rigid cystoscope then insert a guidewire into the ureteral orifice under fluoroscopic guidance. After the guidewire was place correctly, a flexible ureteroscope and stone basket was used to extract stones following by examination of the renal calyces. A total of 30 urology PGTs from 4 urology programs in Quebec participated in this study. The Ureteroscopy-Global rating scale was used to assess all the participants. The PGTs also answered a questionnaire after using the trainer. Three experts also participated to set a competency base line.
The mean score for all PGTs was 20.4 while the mean score for the three experts was 26.0. Based on these numbers, the competency cut-off was set at 19. Based on this, 60% of the 30 participants were rated as competent. PGTs were asked: how close is this simulator to real-life ureteroscopy?, is it useful as an education tool for PGTs?, and do you think the simulator is useful in assessing PGT competency?. They answered on a 1 to 10 scale with a mean rating of 5.3, 6.8, and 5.3 respectively.
Dr. Aloosh concluded that the UroMentor simulator can be used to assess competency in PGTs and established 19 points to be the competency cut-off point under the Ureteroscopy-Global rating scale. He added that PGTs rated as “competent” in this study were significantly better and faster than those who were not. Lastly he stated that future studies with larger sample sizes are needed to confirm these results.
Noureldin YA1, Elkoushy MA2, Andonian S3.
1Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC; ; 2 Department of Urology, Benha University Hospital, Benha University, Benha, Egypt;\
Can Urol Assoc J. 2015 Mar-Apr;9(3-4):E104-8. doi: 10.5489/cuaj.2482.
INTRODUCTION: The first objective was to assess percutaneous renal access (PCA) skills of urology postgraduate trainees (PGTs) during the Objective Structured Clinical Examinations (OSCEs). The second objective was to determine whether previous experience with percutaneous nephrolithotomy (PCNL) improved performance.
METHODS: After obtaining ethics approval, we recruited PGTs from two urology programs in Quebec between postgraduate years (PGY-3 to PGY-5). Each trainee was asked to answer a short questionnaire regarding previous experience in endourologic procedures. After a 3-minute orientation on the PERC Mentor simulator (Simbionix, Cleveland, OH), each trainee was asked to perform task 4, where they had to correctly access all of the renal calyces and pop the balloons in a normal left kidney model. We collected and analyzed data from the questionnaire and the performance report generated by the simulator.
RESULTS: In total, 13 PGTs participated in this study. PGTs had performed a median of 200 (range: 50-1000) cystoscopies, 50 (range: 10-125) TURBTs, 30 (range: 0-100) TURPs, 5 (range: 0-50) laser prostatectomies, and 50 (range: 2-125) ureteroscopies prior to this OSCE. PGTs with previous PCNL experience (8/13) had performed a mean of 18.6 ± 6.3 PCNLs. PGTs with previous PCNL experience performed significantly better in terms of shorter fluoroscopy time (10 ± 1.5 vs. 5.1 ± 0.7 min; p = 0.04), fewer attempts required for successful puncture of the pelvi-calyceal system (PCS) (21 ± 2.3 vs. 13 ± 1.8; p = 0.02), and had significantly lower complications in terms of fewer infundibular injury (7.4 ± 1.5 vs. 2 ± 0.4; p = 0.004) and fewer PCS perforations (11 ± 1.7 vs. 4.5 ± 1.2; p = 0.01).
CONCLUSION: It is feasible to use the PERC Mentor simulator during OSCEs to assess PCA skills of urology PGTs. PGTs who had previous PCNL experience performed significantly better with fewer complications.
Brunckhorst O1, Aydin A1, Abboudi H1, Sahai A1, Khan MS1, Dasgupta P1, Ahmed K2.
1MRC Centre for Transplantation, King’s College London, King’s Health Partners, London, United Kingdom; Department of Urology, Guy’s and St. Thomas’ NHS Foundation Trust, King’s Health Partners, London, United Kingdom.
2MRC Centre for Transplantation, King’s College London, King’s Health Partners, London, United Kingdom; Department of Urology, Guy’s and St. Thomas’ NHS Foundation Trust, King’s Health Partners, London, United Kingdom. Electronic address: firstname.lastname@example.org.
J Surg Educ. 2015 Jan-Feb;72(1):135-43.
OBJECTIVE: Simulation is a common adjunct to operative training and various modalities exist for ureteroscopy. This systematic review aims the following: (1) to identify available ureteroscopy simulators, (2) to explore evidence for their effectiveness using characteristic criterion, and (3) to provide recommendations for simulation-based ureteroscopy training.
DESIGN: The preferred reporting items for systematic reviews and meta-analysis statement guidelines were used. A literature search was performed using the PubMed, EMBASE, and Cochrane Library databases.
RESULTS: In total, 20 articles concerning ureteroscopy simulators were included. Overall, 3 high-fidelity bench models are available. The Uro-Scopic Trainer has demonstrated face, construct, and concurrent validity, whereas the Scope Trainer has undergone content, construct, and predictive validation. The adult ureteroscopy trainer has demonstrated face, content, and construct validity. The URO Mentor is the only available ureteroscopy virtual-reality system; 10 studies were identified demonstrating its face, content, construct, concurrent, and predictive validity. The Uro-Scopic Trainer, the Scope Trainer, and the URO Mentor have demonstrated high educational impact. A noncommercially available, low-fidelity model has demonstrated effectiveness comparable to its high-fidelity counterpart at 185 times lesser than the price of the Uro-Scopic Trainer. The use of porcine models has also been described in 3 studies but require further study.
CONCLUSIONS: Valid models are available for simulation-based ureteroscopy training. However, there is a lack of many high-level studies conducted, and further investigation is required in this area. Furthermore, current research focuses on the technical skills acquisition with little research conducted on nontechnical skills acquisition within ureteroscopy. The next step for ureteroscopy training is a formalized and validated curriculum, incorporating simulation, training models, development of nontechnical skills, and real-life practice.
Zhang Y, Yu CF, Liu JS, Wang G, Zhu H, Na YQ.
Wu Jieping Urology Center, Peking University Shougang Hospital, Beijing 100144, China.
Chin Med J (Engl). 2013 Apr;126(8):1528-31.
BACKGROUND: The need to develop new methods of surgical training combined with advances in computing has led to the development of virtual reality surgical simulators. The PERC Mentor(TM) is designed to train the user in percutaneous renal collecting system access puncture. This study aimed to validate the use of this kind of simulator, in percutaneous renal access training.
METHODS: Twenty-one urologists were enrolled as trainees to learn a fluoroscopy-guided percutaneous renal accessing technique. An assigned percutaneous renal access procedure was immediately performed on the PERC Mentor(TM) after watching instruction video and an analog operation. Objective parameters were recorded by the simulator and subjective global rating scale (GRS) score were determined. Simulation training followed and consisted of 2 hours daily training sessions for 2 consecutive days. Twenty-four hours after the training session, trainees were evaluated performing the same procedure. The post-training evaluation was compared to the evaluation of the initial attempt.
RESULTS: During the initial attempt, none of the trainees could complete the appointed procedure due to the lack of experience in fluoroscopy-guided percutaneous renal access. After the short-term training, all trainees were able to independently complete the procedure. Of the 21 trainees, 10 had primitive experience in ultrasound-guided percutaneous nephrolithotomy. Trainees were thus categorized into the group of primitive experience and inexperience. The total operating time and amount of contrast material used were significantly lower in the group of primitive experience versus the inexperience group (P = 0.03 and 0.02, respectively).
CONCLUSIONS: The training on the virtual reality simulator, PERC Mentor(TM), can help trainees with no previous experience of fluoroscopy-guided percutaneous renal access to complete the virtual manipulation of the procedure independently. This virtual reality simulator may become an important training and evaluation tool in teaching fluoroscopy-guided percutaneous renal access.
Schlickum M, Felländer-Tsai L, Hedman L, Henningsohn L.
Division of Orthopedics, Institution for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
Scand J Urol. 2013 Feb;47(1):38-42. doi: 10.3109/00365599.2012.693538. Epub 2012 Jul 2.
OBJECTIVE: The objective of this study was to examine the correlation between endourological simulator performance and demonstrated theoretical knowledge in the basic surgical sciences.
MATERIAL AND METHODS: In total, 158 fourth year medical students participated in the study, 83 females and 75 males, all surgical novices. All students performed the flexible endoscopic task Hall of Fame in the urological simulator URO Mentor™. Later during the same semester all students took the final theoretical examination in surgery.
RESULTS: In female medical students a significant correlation was found between surgical simulator performance and the examination results (r = -0.22, p = 0.04). There was no statistically significant correlation when looking at the total study population (r = -0.04, p = 0.58) or when looking at male medical students (r = 0.01, p = 0.9).
CONCLUSION: Female medical students completing an endourological simulator task more efficiently passed the theoretical examination in the basic surgical sciences with significantly higher scores than females with low efficiency in the urological simulator. There are likely to be several explanations for this correlation, such as motivation and a lower amount of current video gaming experience.
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