1
|
Kheshvadjian M, Nazmifar M, Rawal R, Davood J, Castaneda P, Dadashian E, Dallmer J, Heard J, Masterson J, Lo E, Taich L, Naser-Tavakolian A, Kokorowski P, Ahdoot M. Implementation and Validation of a High-Fidelity Simulation Model for Surgical Resident Training: Management of Acute Intraoperative Hemorrhage during Robot-assisted Surgery. Urology 2024:S0090-4295(24)00501-6. [PMID: 38936623 DOI: 10.1016/j.urology.2024.06.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/13/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVES To improve our previous simulation-based training module by using sustainable material to mold an anatomically accurate terrain and reproducing major vascular injuries encountered during robot-assisted nephrectomy. METHODS The simulator was built with a pump, gauge, and valve linked via silicone tubing. Artificial blood was made from cornstarch, water, and red dye, and pumped through 3D-Med artificial vessels with the dimensions of an average renal artery. Silicone was used to emulate the pliability of organic tissue and mold an anatomically accurate terrain. Eight urologic residents participated in the pilot simulation. We employed validated assessment tools including Non-Technical Skills for Surgeons and Objective Structured Assessment of Technical Skills forms to guide debrief sessions moderated by an expert physician after individual performance evaluations. RESULTS The apparatus demonstrated high reproducibility across all simulation scenarios, enhancing resident problem-solving skills. Residents' pre-simulation surveys revealed significant concern regarding their acute hemorrhage management. Residents' post-simulation survey demonstrated average realism scores increased from 4.375 to 4.75. Residents also felt the simulator enhanced learning, offering valuable practice and knowledge applicable to their surgical specialty. CONCLUSIONS The management of acute hemorrhage during robot-assisted surgery remains a space for additional surgical education and training. Our simulation successfully provided a reliable, reproducible training for residents to practice their technical and non-technical skills in managing acute hemorrhage.
Collapse
Affiliation(s)
- Michael Kheshvadjian
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA; George Washington University School of Medicine.
| | - Michael Nazmifar
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Rushil Rawal
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Joshua Davood
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Peris Castaneda
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Eman Dadashian
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jeremiah Dallmer
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - John Heard
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - John Masterson
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Eric Lo
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Lior Taich
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Paul Kokorowski
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michael Ahdoot
- Department of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| |
Collapse
|
2
|
Jang T, Kong HJ, Baek C, Kim J, Choo MS, Oh SJ. Effect of Self-Training Using Virtual Reality Head-Mounted Display Simulator on the Acquisition of Holmium Laser Enucleation of the Prostate Surgical Skills. Int Neurourol J 2024; 28:138-146. [PMID: 38956773 PMCID: PMC11222828 DOI: 10.5213/inj.2448042.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/20/2024] [Indexed: 07/04/2024] Open
Abstract
PURPOSE We aimed to evaluate the effect of self-training using a virtual reality head-mounted display simulator on the acquisition of surgical skills for holmium laser enucleation surgery. METHODS Thirteen medical students without surgical skills for holmium laser enucleation of the prostate were trained using multimedia to learn the technique via simulator manipulation. Thereafter, participants performed the technique on a virtual benign prostatic hyperplasia model A (test A). After a 1-week wash-out period, they underwent self-training using a simulator and performed the technique on model B (test B). Subsequently, participants were asked to respond to Training Satisfaction Questions. Video footage of hand movements and endoscope view were recorded during tests A and B for later review by 2 expert surgeons. A 20-step Assessment Checklist, 6-domain Global Rating Scale, and a Pass Rating were used to compare performance on tests A and B. RESULTS Thirteen participants completed both tests A and B. The 20-step Assessment Checklist and 6-domain Global Rating Scale evaluation results showed significantly improved scores in test B than in test A (P<0.05). No evaluator rated participants as passed after test A, but 11 participants (84.6%) passed after test B. Ten participants (76.9%) indicated that the simulator was helpful in acquiring surgical skills for holmium laser enucleation of the prostate. CONCLUSION The virtual reality head-mounted display holmium laser enucleation of the prostate simulator was effective for surgical skill training. This simulator may help to shorten the learning curve of this technique in real clinical practice in the future.
Collapse
Affiliation(s)
- Taesoo Jang
- Department of Biomedical Engineering, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Hyoun-Joong Kong
- Department of Transdisciplinary Medicine, Seoul National University Hospital, Seoul, Korea
| | - Changhoon Baek
- Department of Biomedical Engineering, College of Medicine, Chungnam National University, Daejeon, Korea
- Department of Transdisciplinary Medicine, Seoul National University Hospital, Seoul, Korea
| | - Junki Kim
- Department of Transdisciplinary Medicine, Seoul National University Hospital, Seoul, Korea
| | - Min Soo Choo
- Department of Urology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
3
|
Chahal B, Aydin A, Ahmed K. Virtual reality vs. physical models in surgical skills training. An update of the evidence. Curr Opin Urol 2024; 34:32-36. [PMID: 37962178 PMCID: PMC10715699 DOI: 10.1097/mou.0000000000001145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
PURPOSE OF REVIEW Simulation is a key component of surgical training, enabling trainees to develop their skills in a safe environment. With simulators broadly grouped into physical models and virtual-reality (VR) simulators, it is important to evaluate the comparative effectiveness of the simulator types in terms of validity as well as cost. The review aims to compare the benefits and drawbacks of novel VR and physical simulators within the broader themes of endourology, laparoscopic and robotic operations, and other urological procedures. RECENT FINDINGS Key benefits of bench models include their comparatively lower cost, easy access and provision of haptic feedback, whereas VR simulators are generally self-sufficient, reusable and enable skills of haemostasis to be practised. The advent of perfused 3D printed simulators across a range of urological procedures may replace cadavers as the traditional gold-standard simulation modality. SUMMARY Although possessing differing strengths and downsides, VR and physical simulators when used together can have an additive effect due to skill transferability across the platforms. Further comparative studies are required to directly quantify the differences between physical models and VR simulators in terms of performance metrics and cost-effectiveness. There is lack of validated VR simulators for open and reconstructive procedures.
Collapse
Affiliation(s)
- Baldev Chahal
- MRC Centre for Transplantation, Guy's Hospital, King's College London
| | - Abdullatif Aydin
- MRC Centre for Transplantation, Guy's Hospital, King's College London
- Department of Urology, King's College Hospital NHS Foundation Trust, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London
- Khalifa University
- Department of Urology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| |
Collapse
|
4
|
Wanderling C, Saxton A, Phan D, Sheppard L, Schuler N, Ghazi A. Recent Advances in Surgical Simulation For Resident Education. Curr Urol Rep 2023; 24:491-502. [PMID: 37736826 DOI: 10.1007/s11934-023-01178-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE OF REVIEW Surgical simulation has become a cornerstone for the training of surgical residents, especially for urology residents. Urology as a specialty bolsters a diverse range of procedures requiring a variety of technical skills ranging from open and robotic surgery to endoscopic procedures. While hands-on supervised training on patients still remains the foundation of residency training and education, it may not be sufficient to achieve proficiency for graduation even if case minimums are achieved. It has been well-established that simulation-based education (SBE) can supplement residency training and achieve the required proficiency benchmarks. RECENT FINDINGS Low-fidelity modules, such as benchtop suture kits or laparoscopic boxes, can establish a strong basic skills foundation. Eventually, residents progress to high-fidelity models to refine application of technical skills and improve operative performance. Human cadavers and animal models remain the gold standard for procedural SBE. Recently, given the well-recognized financial and ethical costs associated with cadaveric and animal models, residency programs have shifted their investments toward virtual and more immersive simulations. Urology as a field has pushed the boundaries of SBE and has reached a level where unexplored modalities, e.g., 3D printing, augmented reality, and polymer casting, are widely utilized for surgical training as well as preparation for challenging cases at both the residents, attending and team training level.
Collapse
Affiliation(s)
| | - Aaron Saxton
- Brady Urological Institute, John's Hopkins University, Baltimore, MD, USA
| | - Dennis Phan
- Brady Urological Institute, John's Hopkins University, Baltimore, MD, USA
| | - Lauren Sheppard
- Brady Urological Institute, John's Hopkins University, Baltimore, MD, USA
| | - Nathan Schuler
- Brady Urological Institute, John's Hopkins University, Baltimore, MD, USA
| | - Ahmed Ghazi
- Brady Urological Institute, John's Hopkins University, Baltimore, MD, USA.
| |
Collapse
|
5
|
Joventino CF, Silva RDAAE, Pereira JHM, Yabarrena JMSC, de Oliveira AS. A Sim-to-real Practical Approach to Teach Robotics into K-12: A Case Study of Simulators, Educational and DIY Robotics in Competition-based Learning. J INTELL ROBOT SYST 2023; 107:14. [PMID: 36683970 PMCID: PMC9843091 DOI: 10.1007/s10846-022-01790-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 12/12/2022] [Indexed: 01/18/2023]
Abstract
Simulators in robotics are well-known tools for the development of new applications and training and integration of systems for remote operation or supervision. Therefore, robotics is one of the most used practices in science, technology, engineering, and mathematics-based educational frameworks, and, with COVID-19, simulators have become increasingly important. This study shows specific benefits achieved for K-12 students in an individualized family service plan/resource teachers for the gifted model based on a review. A simulator is typically adopted for undergraduates students to increase their ability to make technical-based decisions and move smoothly between the real and virtual worlds, with a strong emphasis on the feedback from both. It enables students to develop abilities to build robots without needing commercial kits. In a sim-to-real approach, early simulation allows improved team integration and reduced reliance on skills, equalizing the abilities of students, regardless of their backgrounds. Simultaneously, simulation encourages students to work harder in real implementation by equalizing their class level, resulting in competition-based learning.
Collapse
Affiliation(s)
- Carlos Fernando Joventino
- grid.456464.10000 0000 9362 8972Instituto Federal de Educação, Ciência e Tecnologia de São Paulo - IFSP, Av. Clara Gianotti de Souza, Registro, 11900-000 SP Brazil ,grid.474682.b0000 0001 0292 0044Universidade Tecnológica Federal do Paraná - UTFPR, Av. Sete de Setembro, 3165, Curitiba, 80230-901 PR Brazil
| | - Raphael de Abreu Alves e Silva
- grid.456464.10000 0000 9362 8972Instituto Federal de Educação, Ciência e Tecnologia de São Paulo - IFSP, Av. Clara Gianotti de Souza, Registro, 11900-000 SP Brazil
| | - Jonathas H. M. Pereira
- grid.456464.10000 0000 9362 8972Instituto Federal de Educação, Ciência e Tecnologia de São Paulo - IFSP, Av. Clara Gianotti de Souza, Registro, 11900-000 SP Brazil ,grid.474682.b0000 0001 0292 0044Universidade Tecnológica Federal do Paraná - UTFPR, Av. Sete de Setembro, 3165, Curitiba, 80230-901 PR Brazil
| | - Jean Mimar Santa Cruz Yabarrena
- grid.456464.10000 0000 9362 8972Instituto Federal de Educação, Ciência e Tecnologia de São Paulo - IFSP, Av. Clara Gianotti de Souza, Registro, 11900-000 SP Brazil
| | - André Schneider de Oliveira
- grid.474682.b0000 0001 0292 0044Universidade Tecnológica Federal do Paraná - UTFPR, Av. Sete de Setembro, 3165, Curitiba, 80230-901 PR Brazil
| |
Collapse
|
6
|
Liakos N, Moritz R, Leyh-Bannurah SR, Güner Ö, Witt JH, Wagner C. Chicken RAPS: Chicken Robot-assisted Pyeloplasty Simulation. Validation Study of a Novel Chicken Model for Wet Laboratory Training in Robot-assisted Pyeloplasty. EUR UROL SUPPL 2022; 46:82-87. [PMID: 36506253 PMCID: PMC9732448 DOI: 10.1016/j.euros.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 11/09/2022] Open
Abstract
Background Since the introduction of minimally invasive surgery, the number of simulation models available for teaching new surgeons has continued to increase. Objective To evaluate and validate use of a model for teaching robot-assisted pyeloplasty. Design setting and participants Twenty simulated robot-assisted pyeloplasty procedures were performed by experienced (n = 4) and novice (n = 16) surgeons using a chicken crop model at two different training centers using third- and fourth-generation robotic systems. Outcome measurements and statistical analysis We evaluated the time needed to perform the procedure, and the sufficiency and patency of the anastomosis. Participants rated the efficiency, face validity, and possible acceptance of the model as part of a structured curriculum on a scale from 0 to10. Statistical significance for comparison of results was set at p < 0.05. Results and limitations Robot-assisted pyeloplasty was successfully performed by 75% of the participants. The completion time was significantly higher in the novice group (p = 0.016). The model was deemed to be similar to the human ureteropelvic junction by the novice group. Both groups regarded the model as a useful simulation task as part of a standardized training curriculum, with mean scores of 6.5 versus 8.69 (p = 0.046) for face validity and 8 versus 9.25 for acceptance (p = 0.053) reported by the experienced versus novice group, respectively. Limitations of the study are the costs associated with the robotic system and the unequal number of participants in the groups. Conclusions The chicken crop model is a low-cost and reproducible simulation model for accomplishing both the resection and reconstructive steps during the learning phase for robot-assisted pyeloplasty. Patient summary We assessed the use of chickens as a model for practicing a robot-assisted operation called pyeloplasty to fix narrowing of the ureter (the tube that drains urine from the kidney to the bladder) where it attaches to the kidney. This model can be used for simulation of robot-assisted pyeloplasty when training new robotic surgeons.
Collapse
Affiliation(s)
- Nikolaos Liakos
- Department of Urology, Medical Centre of the University of Freiburg, Germany,Corresponding author. Department of Urology, Medical Centre of the University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany. Tel: +49 761 270 28901.
| | - Rudolf Moritz
- Department of Urology, Marien Hospital, Herne, Germany
| | - Sami-Ramzi Leyh-Bannurah
- Department of Urology, Pediatric Urology and Urological Oncology, St. Antonius Hospital, Gronau, Germany
| | - Özlem Güner
- European Robotic Institute Training Center, Gronau, Germany
| | - Jörn H. Witt
- Department of Urology, Pediatric Urology and Urological Oncology, St. Antonius Hospital, Gronau, Germany
| | - Christian Wagner
- Department of Urology, Pediatric Urology and Urological Oncology, St. Antonius Hospital, Gronau, Germany
| |
Collapse
|
7
|
Tjønnås MS, Das A, Våpenstad C, Ose SO. Simulation-based skills training: a qualitative interview study exploring surgical trainees' experience of stress. ADVANCES IN SIMULATION (LONDON, ENGLAND) 2022; 7:33. [PMID: 36273197 PMCID: PMC9588224 DOI: 10.1186/s41077-022-00231-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/09/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Stress can affect the ability to acquire technical skills. Simulation-based training (SBT) courses allow surgical trainees to train their technical skills away from stressful clinical environments. Trainees' subjective experiences of stress during SBT courses on laparoscopic surgery remains understudied. Here, we explored the subjective stress experiences of surgical trainees during mandatory laparoscopic SBT courses. We aimed to obtain a broader understanding of which factors of the simulation training the trainees perceived as eliciting stress. METHODS A qualitative study with semistructured individual interviews was undertaken to explore trainees' subjective experiences of stress. Twenty surgical trainees participated while attending courses at a national training center for advanced laparoscopic surgery. Questions explored trainees' stress experiences during the SBT courses with a focus on perceived stressors related to laparoscopic simulation training on two box-trainers and one virtual reality simulator. Interview data were analyzed using inductive, qualitative content analysis methods to identify codes, categories, and themes. RESULTS Findings indicated that trainees have a variety of stress experiences during laparoscopic SBT. Three main themes were identified to be related to stress experiences: simulation task requirements, psychomotor skill levels and internal pressures, with subcategories such as task difficulty and time requirements, unrealistic haptic feedback and realism of graphics, inconsistent and poor technical performance, and self-imposed pressures and socio-evaluative threats. CONCLUSIONS Insights into surgical trainees' experience of stress during laparoscopic SBT courses showed that some stress experiences were directly related to simulation training, while others were of psychological nature. The technical and efficiency requirements of simulation tasks elicited stress experiences among trainees with less laparoscopic experience and lower levels of psychomotor skills. Self-imposed pressures played an integral part in how trainees mobilized and performed during the courses, suggesting that levels of stress might enhance laparoscopic simulation performance. For course facilitators aiming at optimizing future laparoscopic SBT courses, attending to the realism, providing clarity about learning objectives, and having awareness of individual differences among trainees' technical level when designing the simulation tasks, would be beneficial. Equally important to the laparoscopic SBT is to create a psychological safe learning space in order to reduce the internal pressures of trainees.
Collapse
Affiliation(s)
- Maria Suong Tjønnås
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, N-7491, Trondheim, Norway. .,SINTEF Digital, Department of Health Research, SINTEF, P.O. Box 4760 Torgarden, NO-7465, Trondheim, Norway.
| | - Anita Das
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, N-7491, Trondheim, Norway
| | - Cecilie Våpenstad
- SINTEF Digital, Department of Health Research, SINTEF, P.O. Box 4760 Torgarden, NO-7465, Trondheim, Norway.,Department of Clinical and Molecular Medicine (IKOM), Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, N-7491, Trondheim, Norway.,The national research center for Minimally invasive and Image-guided Diagnostics and Therapy (MiDT), St. Olavs Hospital, Trondheim University Hospital, Prinsesse Kristinas gate 5, Postbox 3250 Torgarden, NO-7006, Trondheim, Norway
| | - Solveig Osborg Ose
- SINTEF Digital, Department of Health Research, SINTEF, P.O. Box 4760 Torgarden, NO-7465, Trondheim, Norway
| |
Collapse
|
8
|
Gasteiger N, van der Veer SN, Wilson P, Dowding D. How, for Whom, and in Which Contexts or Conditions Augmented and Virtual Reality Training Works in Upskilling Health Care Workers: Realist Synthesis. JMIR Serious Games 2022; 10:e31644. [PMID: 35156931 PMCID: PMC8893595 DOI: 10.2196/31644] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/16/2021] [Accepted: 10/12/2021] [Indexed: 01/20/2023] Open
Abstract
Background Using traditional simulators (eg, cadavers, animals, or actors) to upskill health workers is becoming less common because of ethical issues, commitment to patient safety, and cost and resource restrictions. Virtual reality (VR) and augmented reality (AR) may help to overcome these barriers. However, their effectiveness is often contested and poorly understood and warrants further investigation. Objective The aim of this review is to develop, test, and refine an evidence-informed program theory on how, for whom, and to what extent training using AR or VR works for upskilling health care workers and to understand what facilitates or constrains their implementation and maintenance. Methods We conducted a realist synthesis using the following 3-step process: theory elicitation, theory testing, and theory refinement. We first searched 7 databases and 11 practitioner journals for literature on AR or VR used to train health care staff. In total, 80 papers were identified, and information regarding context-mechanism-outcome (CMO) was extracted. We conducted a narrative synthesis to form an initial program theory comprising of CMO configurations. To refine and test this theory, we identified empirical studies through a second search of the same databases used in the first search. We used the Mixed Methods Appraisal Tool to assess the quality of the studies and to determine our confidence in each CMO configuration. Results Of the 41 CMO configurations identified, we had moderate to high confidence in 9 (22%) based on 46 empirical studies reporting on VR, AR, or mixed simulation training programs. These stated that realistic (high-fidelity) simulations trigger perceptions of realism, easier visualization of patient anatomy, and an interactive experience, which result in increased learner satisfaction and more effective learning. Immersive VR or AR engages learners in deep immersion and improves learning and skill performance. When transferable skills and knowledge are taught using VR or AR, skills are enhanced and practiced in a safe environment, leading to knowledge and skill transfer to clinical practice. Finally, for novices, VR or AR enables repeated practice, resulting in technical proficiency, skill acquisition, and improved performance. The most common barriers to implementation were up-front costs, negative attitudes and experiences (ie, cybersickness), developmental and logistical considerations, and the complexity of creating a curriculum. Facilitating factors included decreasing costs through commercialization, increasing the cost-effectiveness of training, a cultural shift toward acceptance, access to training, and leadership and collaboration. Conclusions Technical and nontechnical skills training programs using AR or VR for health care staff may trigger perceptions of realism and deep immersion and enable easier visualization, interactivity, enhanced skills, and repeated practice in a safe environment. This may improve skills and increase learning, knowledge, and learner satisfaction. The future testing of these mechanisms using hypothesis-driven approaches is required. Research is also required to explore implementation considerations.
Collapse
Affiliation(s)
- Norina Gasteiger
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom.,Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, United Kingdom.,Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Paul Wilson
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
| | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom
| |
Collapse
|
9
|
Gleason A, Servais E, Quadri S, Manganiello M, Cheah YL, Simon CJ, Preston E, Graham-Stephenson A, Wright V. Developing basic robotic skills using virtual reality simulation and automated assessment tools: a multidisciplinary robotic virtual reality-based curriculum using the Da Vinci Skills Simulator and tracking progress with the Intuitive Learning platform. J Robot Surg 2022; 16:1313-1319. [DOI: 10.1007/s11701-021-01363-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/30/2021] [Indexed: 12/01/2022]
|
10
|
Park J, Gwak CH, Kim D, Shin JH, Lim B, Kim J, Cheon B, Han J, Kwon DS, Park HK. The usefulness and ergonomics of a new robotic system for flexible ureteroscopy and laser lithotripsy for treating renal stones. Investig Clin Urol 2022; 63:647-655. [DOI: 10.4111/icu.20220237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/09/2022] [Accepted: 09/18/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Juhyun Park
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chan Hoon Gwak
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dongwon Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Hyun Shin
- Department of Urology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Bumjin Lim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | - Jungmin Han
- ROEN Surgical Inc., Daejeon, Korea
- Robotics Program, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Dong-Soo Kwon
- ROEN Surgical Inc., Daejeon, Korea
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Hyung Keun Park
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
11
|
Abstract
PURPOSE OF REVIEW Residency training is a pivotal educational step on the road to becoming a urologist. It combines both clinical and surgical instruction with the goal of producing proficient and compassionate surgeons and clinicians. In this review, we employ a SWOT analysis (Strengths, Weaknesses, Opportunities, and Threats) to investigate the current state of urologic residency training. RECENT FINDINGS Urology remains an attractive and competitive residency with varied and complex surgical and medical training. Areas for improvement include standardization of evaluation and feedback, improving resident wellness, and expanding the use of surgical simulation. Workforce issues such as the predicted urologist supply deficit and poor readiness to enter the business of medicine can be addressed at the residency level. Failure to attract and retain underrepresented minorities, increasing burden of student debt, and resident burnout are serious threats to our field. Using a SWOT analysis we identify key areas for expansion, underscore valuable strengths, and provide a working roadmap for improvement of these formative years.
Collapse
Affiliation(s)
- Luke E Sebel
- Division of Urology, Lahey Hospital and Medical Center, Urology, Burlington, MA, USA
| | - Eric G Katz
- Division of Urology, Lahey Hospital and Medical Center, Urology, Burlington, MA, USA
| | - Lara S MacLachlan
- Division of Urology, Lahey Hospital and Medical Center, Urology, Burlington, MA, USA.
| |
Collapse
|
12
|
Yang M, Peng J, Wang X, Lei H, Li X, Yang K. Reinforcing the effect of microsurgery practice during robotic suturing skill acquisition. Int J Med Robot 2021; 18:e2350. [PMID: 34773438 DOI: 10.1002/rcs.2350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/06/2021] [Accepted: 11/10/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study aimed to examine the effectiveness of microsurgery practice during an interval in robotic surgical training. METHODS Two participant groups with 30 trainees each practiced Thread the Rings 1 on a dV-Trainer. There were four 2-h training sessions, with a 72-h interval between each session. Group A received no additional training during the study period. During every interval, Group B practiced a similar 2-h ring penetration exercise using a microscope three times (once every 24 h). RESULTS The 72-h delay between two sessions for Group A caused the forgetting effect. For Group B, additional microscope-based training aided memory retention. After the training session, Group B presented a significantly higher score than Group A in Thread the Ring 1 learning curves. CONCLUSIONS Adding microsurgical skill training into the basic robotic-surgery training curriculum could be helpful because additional trainings with a binocular microscope could improve robotic surgical skill levels.
Collapse
Affiliation(s)
- Miao Yang
- Zhongnan Hospital, Wuhan University, Wuhan, China
| | | | | | - Hong Lei
- Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Xinyi Li
- Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Kun Yang
- Zhongnan Hospital, Wuhan University, Wuhan, China
| |
Collapse
|
13
|
Dagnaes-Hansen J, Konge L, Andreassen KH, Hansen RB. Virtual reality simulator metrics cannot be used to assess competence in ureteronephroscopy and stone removal - a validation study. Scand J Urol 2021; 55:399-403. [PMID: 34338581 DOI: 10.1080/21681805.2021.1960599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The growing use of simulation-based training makes it necessary to develop efficient training programs in order to ensure optimal use of time and resources. Our aim was to develop and gather validity evidence for a simulation-based test in ureteronephroscopy and set a pass/fail standard for the test that will allow future mastery learning. DESIGN This study is a validation study. A test in ureteronephroscopy and stone removal on the URO Mentor™ virtual reality simulator (3D Systems, USA) was developed by two experienced urologists in order to ensure content. Participants with different experience completed three standardized tasks on the simulator and simulator-generated metrics were used as outcome parameters to minimize bias and ensure a fair response process. RESULTS Twenty novices, 15 intermediates, and 8 experienced urologists were included in the study. Validity evidence for internal structure and relationship to other variables was questionable with weak and mostly insignificant correlations across all four metrics (Cronbach's alpha = 0.14, p = 0.15) and across the three modules (Cronbach's alpha = 0.41 (p = 0.02), 0.35 (p = 0.06), 0.10 (p = 0.35), and 0.30 (p = 0.09) for each metric, respectively). It was not possible to establish a pass/fail score for the simulation test with meaningful consequences. CONCLUSION Our study showed that automatically generated simulator metrics cannot be used as a valid way of assessing competence in ureteronephroscopy. Virtual-reality simulator training could still be a valuable and patient-safe way to practice these skills, but an experienced supervisor is needed to determine when the trainee is ready to continue to supervised practice on patients.
Collapse
Affiliation(s)
- Julia Dagnaes-Hansen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark.,Urological Research Unit, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark
| | - Kim Hovgaard Andreassen
- Department of Urology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Rikke Bølling Hansen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Urology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| |
Collapse
|
14
|
Pfister D, Bündgen M, Schmautz M, Hartmann FH, Heidenreich A. [Influence of the working model on the education of young urologists : Education through the ages]. Urologe A 2021; 60:1432-1439. [PMID: 34170359 DOI: 10.1007/s00120-021-01572-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is a trend of increasing discontent of urologic residents with educational programs. One point being mentioned is lack of time during residency for education and self-training. We analyzed the available time for education in our department depending on the used working model through the last 25 years. MATERIALS AND METHODS We calculated the absolute availability of residents during their residency for working models in 1996, 2000, 2007 and 2017. As a basis we used the working model of 1996 as no compensatory time-off for being on call was used. All days on which a delayed start is planned and no schedule in daily routine is possible had been excluded from education time. The numbers implemented in the regulation on further education in the corresponding years had been used to calculate the expenditure of time on the basis of median length of the different intervention. In addition, the patient numbers on the ward and our outpatient clinic had been documented over time. RESULTS With increasing patient numbers in the in- and outpatient clinic there is a continuous decreasing time available for education. The absolute available time in our department is calculated to be 3.1 years compared to 5 years in 1996. With the first day of training a resident has to complete 66.9 min of self-contained diagnostics or interventions per day in addition to clinical routine and administration to meet the requested numbers of the regulation on further education. CONCLUSIONS The limited time being available for the educational program is improved by the current regulation of education. To teach the complex segments of urology there is an urgent need for a well-structured curriculum, which should be used nationwide.
Collapse
Affiliation(s)
- D Pfister
- Klinik für Urologie, Uroonkologie, spezielle urologische und roboter-assistierte Chirurgie, Kerpener Str. 62, 50937, Köln, Deutschland.
| | | | | | | | | |
Collapse
|
15
|
Pinar U, Freton L, Gondran-Tellier B, Vallée M, Dominique I, Felber M, Khene ZE, Fortier E, Lannes F, Michiels C, Grevez T, Szabla N, Bardet F, Kaulanjan K, Seizilles de Mazancourt E, Matillon X, Pradere B. Educational program in onco-urology for young urologists: What are their needs? Prog Urol 2021; 31:755-761. [PMID: 34154958 DOI: 10.1016/j.purol.2021.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/15/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The emergence of new communication media such as digital contents are progressively replacing more traditional medias in the field of educational programs. Our purpose was to assess urologist in training aspirations regarding urological education. METHODS Members of a national urologist in training association were sent an anonymous online questionnaire regarding their medical formation in the field of urology. Responders interest for urological sub-specialty or education support (new tools and traditional support) were evaluated through a 5-point Likert scale. RESULTS Overall, 109 young urologists (26%) responded to the survey. Most of the respondents worked during their training in an academic hospital (n=89, 82%). The three favorite tools for training chosen by the responders were: videos, workshop or masterclass, and podcasts (responders very interested were respectively n=64 (58.7%), n=50 (45.9%), and n=49 (45%)). E-mail newsletters were reported as the less useful educational tool by participants (n=38, 34.9%). Participants were very interested in improving their surgical skills and their radiological knowledge. Responders who were the most attracted by PCa were much more looking to improve their systemic treatment and radiological knowledges. CONCLUSIONS Urologic-oncology was a priority regarding education for urologists in training. A majority of participants expressed a lack in their surgical education, revealing a reduced OR access and underlining utilization of new tools such as simulation. New digital contents such as social media or podcast achieved high interest for the participants, instead of more traditional media. There is a need that educational content evolve and uses new digital media. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- U Pinar
- GRC n(o) 5, Predictive onco-urology, AP-HP, Hôpital Pitié-Salpêtrière, Urology, Sorbonne université, 75013 Paris, France
| | - L Freton
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - B Gondran-Tellier
- Department of urology, La Conception University Hospital, Assistance-Publique Marseille, Marseille, France
| | - M Vallée
- Department of Urology, Poitiers University Hospital, Poitiers, France
| | - I Dominique
- Department of Urology, groupe hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - M Felber
- GRC n(o) 5, Predictive onco-urology, AP-HP, Hôpital Pitié-Salpêtrière, Urology, Sorbonne université, 75013 Paris, France
| | - Z-E Khene
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - E Fortier
- Department of Urology, Montpellier University Hospital, Montpellier, France
| | - F Lannes
- Department of urology, La Conception University Hospital, Assistance-Publique Marseille, Marseille, France
| | - C Michiels
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - T Grevez
- Department of Urology, CHRU de Tours, Francois-Rabelais University, France
| | - N Szabla
- Department of Urology and Transplantation, Caen University Hospital, Caen, France
| | - F Bardet
- Department of Urology, Dijon University Hospital, Dijon, France
| | - K Kaulanjan
- Department of Urology, CHU de Pointe-à-Pitre, Guadeloupe, France
| | - E Seizilles de Mazancourt
- Department of Urology and Transplantation, Edouard-Herriot Hospital, Hospices civils de Lyon, Lyon, France
| | - X Matillon
- Department of Urology and Transplantation, Edouard-Herriot Hospital, Hospices civils de Lyon, Lyon, France
| | - B Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
16
|
Amato M, Eissa A, Puliatti S, Secchi C, Ferraguti F, Minelli M, Meneghini A, Landi I, Guarino G, Sighinolfi MC, Rocco B, Bianchi G, Micali S. Feasibility of a telementoring approach as a practical training for transurethral enucleation of the benign prostatic hyperplasia using bipolar energy: a pilot study. World J Urol 2021; 39:3465-3471. [PMID: 33538866 PMCID: PMC7859466 DOI: 10.1007/s00345-021-03594-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 01/08/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction Telementoring is one of the applications of telemedicine capable of bringing highly experienced surgeons to areas lacking expertise. In the current study, we aimed to assess a novel telementoring application during the learning curve of transurethral enucleation of the prostate using bipolar energy (TUEB). Material and methods A telementoring system was developed by our engineering department. This application was used to mentor ten prospective cases of TUEB performed by an expert endourologist (novice to the TUEB). A questionnaire was filled by the operating surgeon and the mentor to provide subjective evaluation of the telementoring system. Finally, the outcomes of these patients were compared to a control group consisting of ten consecutive patients performed by the mentor. Results Ten consecutive TUEB were performed using this telementoring application. Delayed and interrupted connection were experienced in two and one patients, respectively; however, their effect was minor, and they did not compromise the safety of the procedure. None of the patients required conversion to conventional transurethral resection of the prostate. Only one patient in our series experienced grade IIIb complication. Conclusion The telementoring application for TUEB is promising. It is a simple and low-cost tool that could be a feasible option to ensure patients’ safety during the initial phase of the learning curve without time and locations constraints for both the mentor and the trainee; However, it should be mentioned that telementoring cannot yet replace the traditional surgical training with the mentor and trainee being in the operative room. Further studies are required to confirm the current results Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03594-9.
Collapse
Affiliation(s)
- Marco Amato
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.,ORSI Academy, Melle, Belgium
| | - Ahmed Eissa
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.,Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.,ORSI Academy, Melle, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Cristian Secchi
- Department of Sciences and Methods for Engineering (DISMI), University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Federica Ferraguti
- Department of Sciences and Methods for Engineering (DISMI), University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Marco Minelli
- Department of Sciences and Methods for Engineering (DISMI), University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | | | - Isotta Landi
- Department of Psychology and Cognitive Sciences, University of Trento, Royereto, Italy
| | - Giulio Guarino
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Maria Chiara Sighinolfi
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Giampaolo Bianchi
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.
| |
Collapse
|
17
|
Ghazi A, Melnyk R, Hung AJ, Collins J, Ertefaie A, Saba P, Gurung P, Frye T, Rashid H, Wu G, Mottrie A, Costello T, Dasgupta P, Joseph J. Multi-institutional validation of a perfused robot-assisted partial nephrectomy procedural simulation platform utilizing clinically relevant objective metrics of simulators (CROMS). BJU Int 2020; 127:645-653. [PMID: 32936977 DOI: 10.1111/bju.15246] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To conduct a multi-institutional validation of a high-fidelity, perfused, inanimate, simulation platform for robot-assisted partial nephrectomy (RAPN) using incorporated clinically relevant objective metrics of simulation (CROMS), applying modern validity standards. MATERIALS AND METHODS Using a combination of three-dimensional (3D) printing and hydrogel casting, a RAPN model was developed from the computed tomography scan of a patient with a 4.2-cm, upper-pole renal tumour (RENAL nephrometry score 7×). 3D-printed casts designed from the patient's imaging were used to fabricate and register hydrogel (polyvinyl alcohol) components of the kidney, including the vascular and pelvicalyceal systems. After mechanical and anatomical verification of the kidney phantom, it was surrounded by other relevant hydrogel organs and placed in a laparoscopic trainer. Twenty-seven novice and 16 expert urologists, categorized according to caseload, from five academic institutions completed the simulation. RESULTS Clinically relevant objective metrics of simulators, operative complications, and objective performance ratings (Global Evaluative Assessment of Robotic Skills [GEARS]) were compared between groups using Wilcoxon rank-sum (continuous variables) and parametric chi-squared (categorical variables) tests. Pearson and point-biserial correlation coefficients were used to correlate GEARS scores to each CROMS variable. Post-simulation questionnaires were used to obtain subjective supplementation of realism ratings and training effectiveness. RESULTS Expert ratings demonstrated the model's superiority to other procedural simulations in replicating procedural steps, bleeding, tissue texture and appearance. A significant difference between groups was demonstrated in CROMS [console time (P < 0.001), warm ischaemia time (P < 0.001), estimated blood loss (P < 0.001)] and GEARS (P < 0.001). Six major intra-operative complications occurred only in novice simulations. GEARS scores highly correlated with the CROMS. CONCLUSIONS This perfused, procedural model offers an unprecedented realistic simulation platform, which incorporates objective, clinically relevant and procedure-specific performance metrics.
Collapse
Affiliation(s)
- Ahmed Ghazi
- Department of Urology, University of Rochester, Rochester, NY, USA.,Simulation Innovation Laboratory, University of Rochester, Rochester, NY, USA
| | - Rachel Melnyk
- Simulation Innovation Laboratory, University of Rochester, Rochester, NY, USA
| | - Andrew J Hung
- Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Justin Collins
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Ashkan Ertefaie
- Department of Biostatistics, University of Rochester, NY, USA
| | - Patrick Saba
- Simulation Innovation Laboratory, University of Rochester, Rochester, NY, USA
| | - Pratik Gurung
- Department of Urology, University of Rochester, Rochester, NY, USA
| | - Thomas Frye
- Department of Urology, University of Rochester, Rochester, NY, USA
| | - Hani Rashid
- Department of Urology, University of Rochester, Rochester, NY, USA
| | - Guan Wu
- Department of Urology, University of Rochester, Rochester, NY, USA
| | - Alex Mottrie
- Urological Department, OLV Hospital, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | - Tony Costello
- Department Departments of Surgery and Urology, University of Melbourne and Royal Melbourne Hospital, Melbourne, Vic., Australia.,Australian Medical Robotics Academy (AMRA), Melbourne, Vic., Australia
| | - Prokar Dasgupta
- Chair of Urology, Life Sciences and Medicine, King's College London, London, UK
| | - Jean Joseph
- Department of Urology, University of Rochester, Rochester, NY, USA
| |
Collapse
|
18
|
Abstract
PURPOSE OF REVIEW The goal of this paper was to identify areas of importance in modern urology education that are not currently emphasized in current urological curricula. RECENT FINDINGS We identified curricular deficits in robotic surgical simulation, transgender health, leadership, business management, and social media training. Few practicing urologists feel comfortable managing transgender-specific needs, and most training programs do not adequately address transgender health. Urology programs also do not sufficiently emphasize topics in leadership, business management, or appropriate social media usage. With respect to simulation, while it is currently included in the Accreditation Council for Graduate Medical Education (ACGME) program requirements, it is currently under-utilized for training in robotic surgery. It is important for urologists to receive adequate training for the modern practice landscape. Where knowledge gaps among early practicing urologists arise, programs should adapt their curricula to address them.
Collapse
|
19
|
Lentz AC, Rodríguez D, Chandrapal JC, Davis LG, Ghazi A, Gross MS, Munarriz R. Cadaveric Laboratory Simulation Training of Male Stress Urinary Incontinence Treatment Improves Trainee Knowledge and Confidence. Urology 2020; 143:48-54. [PMID: 32574602 DOI: 10.1016/j.urology.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/16/2020] [Accepted: 06/09/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess whether a focused, simulation training course can improve trainee surgical knowledge and confidence in the treatment of male stress urinary incontinence. MATERIALS AND METHODS Urology residents participated in a prosthetic education course as part of the 2018 SUPS and SMSNA annual meeting. The course included didactic lectures and a hands-on cadaveric laboratory. Participants completed questionnaires before and after the lab (2 weeks and 6 months) to assess procedural knowledge and confidence. Analysis of lab responses was performed using the Wilcoxon signed rank test for matched pairs. RESULTS Thirty-two residents (median age 29, range 27-34) participated in the course. The majority were postgraduate year 4 (63%) or postgraduate year 5 (20%). Most participants reported minimal AUS or sling experience with 50% and 94% reporting less than 5 cases, respectively. Overall score from the knowledge assessment improved significantly between the pre-lab versus 2-week post-lab (P = .02) and pre-lab versus 6-month post-lab (P = .01). Similarly, procedural confidence improved between pre-lab vs 2-week post-lab (P < .001) and pre-lab versus 6-month post-lab (P < .001). Knowledge and confidence assessments were not different between year of residency training or pre-lab experience. CONCLUSIONS Simulation training improves knowledge and confidence in prosthetic surgery for male stress incontinence. In the current climate of reduced exposure and limited availability of prosthetic educators, simulation courses can provide much needed educational value.
Collapse
Affiliation(s)
- Aaron C Lentz
- Division of Urologic Surgery, Duke University School of Medicine, Durham, NC.
| | | | - Jason C Chandrapal
- Division of Urologic Surgery, Duke University School of Medicine, Durham, NC
| | - Leah G Davis
- Division of Urologic Surgery, Duke University School of Medicine, Durham, NC
| | | | | | | |
Collapse
|
20
|
Canalichio KL, Berrondo C, Lendvay TS. Simulation Training in Urology: State of the Art and Future Directions. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:391-396. [PMID: 32581620 PMCID: PMC7276194 DOI: 10.2147/amep.s198941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/10/2020] [Indexed: 05/08/2023]
Abstract
There has been a major shift from the old paradigm of 'see one, do one, teach one' in medical training due in large part to resident work-hour restrictions and required oversight in the operating room. In response to this, advancements in technology have allowed for the introduction of more objective measures to assess the skill competency and proficiency of surgical trainees. Patient safety and trainee well-being are important drivers for this new model, and so surgical training programs are adopting simulation into their curriculum. Urology is uniquely positioned at the forefront of new emerging technologies in surgery, because of the field's commitment to safe and efficient minimally invasive surgery and endourological procedures. Due to these technically challenging procedures, urological training must incorporate these educational technologies to allow for objective skills assessment, skills transfer, and ultimately providing optimal patient care with the production of proficient and competent urological trainees.
Collapse
Affiliation(s)
- Katie Lynn Canalichio
- Pediatric Urology, Seattle Children’s Hospital, Seattle, WA, USA
- Urology, University of Washington, Seattle, WA, USA
- Correspondence: Katie Lynn Canalichio Pediatric Urology, Seattle Children’s Hospital, OA.9.220 PO Box 5371, Seattle, WA98145-5005, USATel +1 206 987 6913Fax +1 206 987 3155 Email
| | - Claudia Berrondo
- Pediatric Urology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Thomas S Lendvay
- Pediatric Urology, Seattle Children’s Hospital, Seattle, WA, USA
- Urology, University of Washington, Seattle, WA, USA
| |
Collapse
|