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Cepek J, Wilson C, Denstedt JD, Stern N, Razvi H, Bjazevic J, Dave S, Wang P. Portable Endoscopic Simulator for Urological Training: A Face/Content and Construct Validity Study. J Endourol 2022; 36:1495-1501. [PMID: 35546282 DOI: 10.1089/end.2022.0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Mastering a surgical skill requires experience and repetition, yet opportunities for surgical trainees to gain real experience is variable and limited by case load. Surgical simulators have emerged in an attempt to overcome these limitations. However, the few currently available skills simulators for flexible endoscopy are costly, have limited accessibility and versatility, lack portability, and require dedicated time for practice. The use of a portable skills simulator to teach flexible endoscopy may provide a feasible alternative. This study introduces a novel, low-cost, portable, endoscopic simulation system for training basic endoscopic skills. Using custom software, the simulator presents a virtual environment featuring 3D models of anatomy, endoscopes, and endoscopic tools. The virtual endoscope and its tools are directly controlled in the simulation by motion input from a custom-manufactured portable endoscopic controller that communicates data via a Bluetooth interface. This two-part study presents proof of concept and initial pilot data examining the face/content validity and preliminary construct validity of the portable endoscopic simulator. In part one, experts (n = 2) and novices (n = 6) provided ratings of fidelity and utility as a training tool. In part two, experts (n = 4) and novices (n = 4) completed 10 simulated sequential basic endoscopic tasks and time to completion was assessed. Findings indicate that the simulator has good utility as a training tool, but some features require modification to be more realistic. Further, both novices and experts improved on the task with repeated measurements (p < .001), but there were no significant differences between experts and novices in time to completion. Although more robust validation is required, this simulator appears promising as a feasible and cost-effective tool for providing simulation training on basic endoscopic skills.
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Affiliation(s)
- Jeremy Cepek
- Western University Schulich School of Medicine & Dentistry, 70384, London, Ontario, Canada;
| | - Claire Wilson
- London Health Sciences Centre Children's Hospital, 10000, 800 Commissioners Rd., London, Ontario, Canada, N6A 5W9;
| | - John D Denstedt
- UWO, 6221, st Josephs hospital, London, Ontario, Canada, N6A 3K7;
| | - Noah Stern
- Western University Schulich School of Medicine & Dentistry, 70384, London, Ontario, Canada;
| | - Hassan Razvi
- Western University Schulich School of Medicine & Dentistry, 70384, London, Ontario, Canada;
| | - Jennifer Bjazevic
- Western University Schulich School of Medicine & Dentistry, 70384, London, Ontario, Canada;
| | - Sumit Dave
- Western University Schulich School of Medicine & Dentistry, 70384, London, Ontario, Canada;
| | - Peter Wang
- London Health Sciences Centre, 10033, Surgery, 800 Commissioners Road East, B1-147, London, Ontario, Canada, N6A 5W9.,Ontario, Canada;
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García-Perdomo HA, Echeverría-García F, Gutiérrez Rojas AF. El rol de la simulación en la practica y entrenamiento urológico. Rev Urol 2021. [DOI: 10.1055/s-0041-1736204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Herney Andrés García-Perdomo
- Departamento de Cirugía/Urología. Grupo de Investigación UROGIV. Escuela de Medicina. Universidad del Valle. Cali, Colombia
| | - Fernando Echeverría-García
- Departamento de Cirugía/Urología. Grupo de Investigación UROGIV. Escuela de Medicina. Universidad del Valle. Cali, Colombia
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Prudhomme T, Matillon X, Dengu F, de Mazancourt E, Pinar U, Gondran-Tellier B, Freton L, Vallée M, Dominique I, Felber M, Khene ZE, Fortier E, Lannes F, Michiels C, Grevez T, Szabla N, Bardet F, Kaulanjan K, Pradère B, Deschamps JY, Branchereau J. Residents and patients benefit from surgical simulation on a live porcine model, could we consider it as ethical? Prog Urol 2021; 31:618-626. [PMID: 34158220 DOI: 10.1016/j.purol.2021.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/16/2021] [Accepted: 01/29/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The objective was to evaluate, by self-questionnaire, the feeling of participants in surgical training sessions on a live porcine model. METHODS A computerized questionnaire (GoogleForm ©) was sent to the members of the French Association of Urologists-in-Training (AFUF) (fellows and residents). Only questionnaires from Urologists-in-training who had participated in surgical training sessions were included. The sessions consisted of performing surgeries such as laparoscopic nephrectomies or laparoscopic cystectomies. RESULTS Overall, 198 met the inclusion criteria. A total of 36.4% (72/198) of the participants were fellows and 63.6% (126/198) were residents. According to the participants, the main interest of sessions was to be able to train for emergency situations. A total of 79.8% (158/198) of the participants wanted surgical simulation to become compulsory. To their opinion, the main advantage of surgical simulation on a live porcine model was: technical progress in 87.4% (173/198) of cases. A total of 13.1% (26/198) of the participants found it was unethical to perform the first technical procedures on live animal models. A total of 65.7% (130/198) of the participants considered that there is currently no system of substitution. CONCLUSION For the participants, surgical training on a live porcine model allows technical progress while training for serious emergency situations. Surgeons and patients could benefit from this risk-free mock surgical scenario. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- T Prudhomme
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU de Nantes, 44093 Nantes, France; Centre de Recherche en Transplantation et Immunologie (CRTI), UMR1064, INSERM, Université de Nantes, Nantes, France; Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France.
| | - X Matillon
- Department of Urology and Transplantation, Hospices civils de Lyon, Lyon, France
| | - F Dengu
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - E de Mazancourt
- Department of Urology and Transplantation, Hospices civils de Lyon, Lyon, France
| | - U Pinar
- Department of Urology, University Paris Saclay, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - B Gondran-Tellier
- Department of Urology, La Conception University Hospital, Assistance-Publique Marseille, Marseille, France
| | - L Freton
- Department of Urology, University Hospital of Rennes, Rennes, 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
- Department of Urology, Pitié-Salpêtrière Hospital, AP-HP, 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, Tours University Hospital, Tours, 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, Pointe à Pitre University Hospital, Guadeloupe, France
| | - B Pradère
- Department of Urology, Tours University Hospital, Tours, France
| | - J-Y Deschamps
- Emergency and Critical Care Unit, ONIRIS, School of Veterinary Medecine, La Chantrerie, Nantes, France
| | - J Branchereau
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU de Nantes, 44093 Nantes, France; Centre de Recherche en Transplantation et Immunologie (CRTI), UMR1064, INSERM, Université de Nantes, Nantes, France; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
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Racy M, Barrow A, Tomlinson J, Bello F. Development and Validation of a Virtual Reality Haptic Femoral Nailing Simulator. JOURNAL OF SURGICAL EDUCATION 2021; 78:1013-1023. [PMID: 33162363 DOI: 10.1016/j.jsurg.2020.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 08/17/2020] [Accepted: 10/09/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To create a virtual reality (VR) femoral nailing simulator combining haptics and image intensifier functionality and then carry out validation studies to assess its educational value. DESIGN The simulator consisted of a 3D virtual environment, a haptic device and 3D printed drill handle and a VR headset. The environment was created using a video game development engine, interfaced with plugins to allow haptic feedback and image intensifier functionality. Two tasks were created within the simulator as part of an antegrade femoral intramedullary (IM) nail procedure: proximal guidewire entry and distal locking.For the validation study, participants performed the above tasks on the simulator. Metrics were collected including time taken, number of X-rays and tool distance travelled and used to assess construct validity. A questionnaire was then completed to assess authenticity and content validity. SETTING Simulator development in centre for simulation and engagement science laboratory. Validation study in a teaching hospital environment. PARTICIPANTS Orthopedic specialist trainees and consultants. RESULTS Surgeon experience (number of IM nails performed/postgraduate year) correlated with significantly improved task performance. More experienced surgeons took less time, used fewer X-rays and had greater economy of movement than less experienced surgeons. Authenticity and content validity were well rated, with criticisms primarily due to hardware limitations. CONCLUSIONS To our knowledge this is the first orthopedic simulator to combine immersive VR with haptics and full image intensifier functionality. By combining multiple aspects of surgical practice within a single device, we aimed to improve participant immersion and educational value. Our work so far has focused on technical skills, demonstrating good authenticity, content and construct validity, however our findings show promise in other applications such as nontechnical skill development and assessment.
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Affiliation(s)
- Malek Racy
- Imperial College London, Centre for Engagement and Simulation Science, Imperial College London, 3rd Floor Chelsea and Westminster Hospital (Academic Surgery), London, United Kingdom; Sheffield Teaching Hospitals NHSFT, Northern General Hospital, Sheffield, United Kingdom.
| | - Alastair Barrow
- Imperial College London, Centre for Engagement and Simulation Science, Imperial College London, 3rd Floor Chelsea and Westminster Hospital (Academic Surgery), London, United Kingdom
| | - James Tomlinson
- Sheffield Teaching Hospitals NHSFT, Northern General Hospital, Sheffield, United Kingdom
| | - Fernando Bello
- Imperial College London, Centre for Engagement and Simulation Science, Imperial College London, 3rd Floor Chelsea and Westminster Hospital (Academic Surgery), London, United Kingdom
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Small C, Nwafor D, Patel D, Dawoud F, Dagra A, Ciporen J, Lucke-Wold B. Crisis Management Simulation: Review of Current Experience. SUNTEXT REVIEW OF NEUROSCIENCE & PSYCHOLOGY 2021; 2:126. [PMID: 33928268 PMCID: PMC8081329 DOI: 10.51737/2766-4503.2021.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Crisis management simulation is important in training the next generation of surgeons. In this review, we highlight our experiences with the cavernous carotid injury model. We then delve into other crisis simulation models available for the neurosurgical specialty. The discussion focuses upon how these trainings can continue to evolve. Much work is yet to be done in this exciting arena and we present several avenues for future discovery. Simulation continues to be an important training tool for the surgical learner.
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Affiliation(s)
| | | | - Devan Patel
- College of Medicine, Florida State University
| | - Fakhry Dawoud
- College of Medicine, East Tennessee State University
| | | | - Jeremy Ciporen
- Department of Neurosurgery, Oregon Health and Science University
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Niang L, Jalloh M, Houlgatte A, Ndoye M, Diallo A, Labou I, Mane IL, Mbodji M, Gueye SM. Simulation Training in Endo-urology: a New Opportunity for Training in Senegal. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00620-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Schlottmann F, Tolleson-Rinehart S, Kibbe MR, Patti MG. Status of Simulation-Based Training in Departments of Surgery in the United States. J Surg Res 2020; 255:158-163. [DOI: 10.1016/j.jss.2020.05.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/13/2020] [Accepted: 05/03/2020] [Indexed: 02/07/2023]
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Lu J, Thandapani K, Kuo T, Tiong HY. Validation of laparoscopy and flexible ureteroscopy tasks in inanimate simulation training models at a large-scale conference setting. Asian J Urol 2019; 8:215-219. [PMID: 33996479 PMCID: PMC8099649 DOI: 10.1016/j.ajur.2019.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 08/12/2019] [Accepted: 10/24/2019] [Indexed: 01/10/2023] Open
Abstract
Objective Simulation based training with training models is being increasingly used as a tool to help trainees mount the learning curve. However, validation studies of surgical simulators are often limited by small numbers. We aim to evaluate the feasibility of validating simulation-training tasks in laparoscopy and flexible ureteroscopy (FURS) rapidly at a large-scale conference setting for residents. Methods Seventy-six urology residents from various Asian countries were assessed on their laparoscopic and FURS skills during the 14th Urological Association of Asia Congress 2016. Residents performed the peg transfer task from the fundamentals of laparoscopic surgery (FLS) and completed inspection of calyces and stone retrieval using a flexible ureteroscope in an endourological model. Each participant's experience (no experience, 1–30 or >30 procedures) in laparoscopy, rigid ureteroscopy (RURS) and FURS was self-reported. Results Median time taken to complete the laparoscopic task decreased with increasing laparoscopic experience (209 s vs. 177 s vs. 145 s, p=0.008) whereas median time taken to complete the FURS tasks reduced with increasing FURS experience (405 s vs. 250 s vs. 163 s, p=0.003) but not with RURS experience (400.5 s vs. 397 s vs. 331 s, p=0.143), demonstrating construct validity. Positive educational impact of both tasks was high, with mean ratings of 4.16/5 and 4.10/5 respectively, demonstrating face validity. Conclusion Our study demonstrates construct and face validities of laparoscopy and FURS simulation tasks among residents at a conference setting. Validation studies at a conference setting can be an effective avenue for evaluating simulation models and curriculum in the future.
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Affiliation(s)
- Jirong Lu
- Department of Urology, National University Hospital, Singapore
- Corresponding author.
| | | | - Tricia Kuo
- Department of Urology, Singapore General Hospital, Singapore
- Urology Service, Sengkang Health, Singapore
| | - Ho Yee Tiong
- Department of Urology, National University Hospital, Singapore
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Benefits and Limitations of Transurethral Resection of the Prostate Training With a Novel Virtual Reality Simulator. Simul Healthc 2019; 15:14-20. [PMID: 31743314 DOI: 10.1097/sih.0000000000000396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Profound endourological skills are required for optimal postoperative outcome parameters after transurethral resection of the prostate (TURP). We investigated the Karl Storz (Tuttlingen, Germany) UroTrainer for virtual simulation training of the TURP. MATERIALS AND METHODS Twenty urologists underwent a virtual reality (VR) TURP training. After a needs analysis, performance scores and self-rated surgical skills were compared before and after the curriculum, the realism of the simulator was assessed, and the optimal level of experience for VR training was evaluated. Statistical testing was done with SPSS 25. RESULTS Forty percent of participants indicated frequent intraoperative overload during real-life TURP and 80% indicated that VR training might be beneficial for endourological skills development, underlining the need to advance classical endourological training. For the complete cohort, overall VR performance scores (P = 0.022) and completeness of resection (P < 0.001) significantly improved. Self-rated parameters including identification of anatomical structures (P = 0.046), sparing the sphincter (P = 0.002), and handling of the resectoscope (P = 0.033) became significantly better during the VR curriculum. Participants indicated progress regarding handling of the resectoscope (70%), bleeding control (55%), and finding the correct resection depth (50%). Although overall realism and handling of the resectoscope was good, virtual bleeding control and correct tissue feedback should be improved in future VR simulators. Seventy percent of participants indicated 10 to 50 virtual TURP cases to be optimal and 80% junior residents to be the key target group for VR TURP training. CONCLUSIONS There is a need to improve training the TURP and VR simulators might be a valuable supplement, especially for urologists beginning with the endourological desobstruction of the prostate.
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Virtual Reality Simulation in Nontechnical Skills Training for Healthcare Professionals. ACTA ACUST UNITED AC 2019; 14:188-194. [DOI: 10.1097/sih.0000000000000347] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Flanders D, Pirpiris A, Corcoran N, Forsyth R, Grills R. Lessons Learned and New Challenges: Re-evaluation of End-User Assessment of a Skills-Based Training Program for Urology Trainees. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2019; 6:2382120519834552. [PMID: 30886895 PMCID: PMC6415477 DOI: 10.1177/2382120519834552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 01/31/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To re-assess the perceived benefit and relevance of simulation sessions to Victorian urology trainees and to identify areas for potential improvement. SUBJECTS AND METHODS All trainees attending skills training sessions between 2011 and 2016 were asked to complete a structured questionnaire at the completion of the session. The questionnaire included 11 topic areas ranging from the year of surgical training to degree of usefulness of the session, including several sections for free-text response to offer more detailed feedback. Sessions were examined both individually and collectively to assess end-user satisfaction with the structure and content of the program. RESULTS In total, 24 individual skills sessions were held over the 6-year period, with a total of 355 attendees. Of these, 331 attendees completed the majority of the questionnaire, a response rate of over 93%. Overall 88% of the surveyed attendees stated that they had both the support of their supervising consultant and the flexibility of workload to attend the session; 90% of trainees felt that there was adequate reading material provided prior to the skills session, an improvement from 76% in the previous study period; and 97% of those surveyed felt that the existing session structure was appropriate and the same proportion found the sessions both useful and interesting, compared with just 63% in the previous study period. Analysis of individual topics demonstrates some variability in outcome measures, but for nearly every assessed parameter, greater than 90% of participants agreed that the session fulfilled the expected criteria. New topics developed since the 2011 analysis, including renal transplant and vascular repair, also had high levels of satisfaction. The practical models used have been refined and achieved higher scores than those in the previous assessment period. CONCLUSION The urology skills-based training program has been well received by the surveyed trainees and is now embedded and accepted as part of the Victorian training program. The format of the sessions has matured and the overall rating, both individually and collectively, was high. There has been a clear increase in satisfaction across most areas assessed when compared with previous feedback. Despite this, there remain areas that can be improved, such as the amount and quality of available equipment and the inclusion of video demonstrations of operative techniques.
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Affiliation(s)
- Damian Flanders
- Department of Urological Surgery, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
| | - Athina Pirpiris
- Department of Urological Surgery, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
| | - Niall Corcoran
- Department of Urology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia
- Australian Prostate Cancer Research Centre Epworth, Melbourne, VIC, Australia
- Urology Department, Frankston Hospital, Melbourne, VIC, Australia
| | - Robert Forsyth
- Urology Department, Ballarat Health Services, Ballarat, VIC, Australia
- St John of God Health Care, Ballarat, VIC, Australia
- Urological Society of Australia and New Zealand, Sydney, NSW, Australia
| | - Richard Grills
- Department of Urological Surgery, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
- Urological Society of Australia and New Zealand, Sydney, NSW, Australia
- Department of Surgery, Deakin University, Geelong, VIC, Australia
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Kwong JC, Lee JY, Goldenberg MG. Understanding and Assessing Nontechnical Skills in Robotic Urological Surgery: A Systematic Review and Synthesis of the Validity Evidence. JOURNAL OF SURGICAL EDUCATION 2019; 76:193-200. [PMID: 29958854 DOI: 10.1016/j.jsurg.2018.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/17/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Robotic urological surgery (RUS) has seen widespread adoption across institutions in the last decade. To match this rapid growth, it is imperative to develop a structured RUS curriculum that addresses both technical and nontechnical competencies. Emerging evidence has shown that nontechnical skills form a critical component of RUS training. The purpose of this review is to examine the validity evidence of available nontechnical skills assessment tools in RUS. METHODS A literature search of MEDLINE, EMBASE, and PsycINFO was conducted to identify primary articles using nontechnical skills assessment tools in RUS. Messick's validity framework and the Medical Education Research Study Quality Instrument were utilized to evaluate the quality of the validity evidence of the abstracted articles. RESULTS Of the 566 articles identified, 12 used nontechnical skills assessment tools in RUS. The metrics used ranged from self-assessment using global rating scales, to objective measures such as electroencephalography. The setting of these evaluations ranged from immersive and virtual reality-based simulators to live surgery. CONCLUSIONS Limited effort has been made to develop nontechnical skills assessment tools in RUS. Recently, there has been a shift from subjective to objective measures of nontechnical performance, as well as the development of assessments specific to RUS. However, the validity evidence supporting these nontechnical assessments is limited at this time, including their relationship to technical skills, and their impact on surgical outcomes.
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Affiliation(s)
- Jethro Cc Kwong
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jason Y Lee
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Mitchell G Goldenberg
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
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Virtual Reality and Simulation for Progressive Treatments in Urology. Int Neurourol J 2018; 22:151-160. [PMID: 30286577 PMCID: PMC6177729 DOI: 10.5213/inj.1836210.105] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 09/26/2018] [Indexed: 12/20/2022] Open
Abstract
In urology technologies and surgical practices are constantly evolving and virtual reality (VR) simulation has become a significant supplement to existing urology methods in the training curricula of urologists. However, new developments in urology also require training and simulation for a wider application. In order to achieve this VR and simulation could play a central role. The purpose of this article is a review of the principal applications for VR and simulation in the field of urology education and to demonstrate the potential for the propagation of new progressive treatments. Two different cases are presented as examples: exposure therapy for paruresis and virtual cystoscopy for diagnosis and surgery of bladder cancer. The article uses research and publications listed in openly accessible directories and is organized into 3 sections: The first section covers features of VR and simulation technologies. The second one presents confirmed applications of current technologies in urology education and showcases example future applications in the domain of bladder treatment and surgery. The final section discusses the potential of the technology to improve health care quality.
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Aydin A, Fisher R, Khan MS, Dasgupta P, Ahmed K. Training, assessment and accreditation in surgery. Postgrad Med J 2017; 93:441-448. [DOI: 10.1136/postgradmedj-2016-134701] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/06/2017] [Accepted: 04/02/2017] [Indexed: 12/16/2022]
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Aydin A, Ahmed K, Shafi AM, Khan MS, Dasgupta P. The role of simulation in urological training – A quantitative study of practice and opinions. Surgeon 2016; 14:301-307. [DOI: 10.1016/j.surge.2015.06.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/04/2015] [Indexed: 11/16/2022]
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de Vries AH, van Genugten HG, Hendrikx AJ, Koldewijn EL, Schout BM, Tjiam IM, van Merriënboer JJ, Muijtjens AM, Wagner C. The Simbla TURBT Simulator in Urological Residency Training: From Needs Analysis to Validation. J Endourol 2016; 30:580-7. [DOI: 10.1089/end.2015.0723] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anna H. de Vries
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Ad J.M. Hendrikx
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
| | - Evert L. Koldewijn
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Barbara M.A. Schout
- Department of Urology, Alrijne Hospital, Leiden, The Netherlands
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Irene M. Tjiam
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Arno M.M. Muijtjens
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Cordula Wagner
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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Brunckhorst O, Volpe A, van der Poel H, Mottrie A, Ahmed K. Training, Simulation, the Learning Curve, and How to Reduce Complications in Urology. Eur Urol Focus 2016; 2:10-18. [DOI: 10.1016/j.euf.2016.02.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/08/2016] [Indexed: 12/14/2022]
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Rashid P, Gianduzzo TR. Urology technical and non-technical skills development: the emerging role of simulation. BJU Int 2015; 117 Suppl 4:9-16. [DOI: 10.1111/bju.13259] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Prem Rashid
- Department of Urology; Rural Clinical School; The University of New South Wales; Port Macquarie Base Hospital; Port Macquarie NSW Australia
| | - Troy R.J. Gianduzzo
- Department of Urology; School of Medicine; The University of Queensland; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
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Soria F, Morcillo E, Serrano A, Cansino R, Rioja J, Fernandez I, de la Cruz J, Van Cleynenbreugel B, Sanchez-Margallo FM. Development and Validation of a Novel Skills Training Model for Retrograde Intrarenal Surgery. J Endourol 2015; 29:1276-81. [DOI: 10.1089/end.2015.0421] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Federico Soria
- Department of Endourology-Endoscopy, Minimally Invasive Surgery Centre Jesús Usón, Cáceres, Spain
| | - Esther Morcillo
- Department of Endourology-Endoscopy, Minimally Invasive Surgery Centre Jesús Usón, Cáceres, Spain
| | - Alvaro Serrano
- Department of Urology, University Hospital Clinico San Carlos, Madrid, Spain
| | - Ramon Cansino
- Department of Urology, University Hospital La Paz, Madrid, Spain
| | - Jorge Rioja
- Department of Urology, University Hospital Miguel Servet, Zaragoza, Spain
| | | | - Julia de la Cruz
- Department of Endourology-Endoscopy, Minimally Invasive Surgery Centre Jesús Usón, Cáceres, Spain
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21
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Role of transurethral resection of the prostate simulators for training in transurethral surgery. Curr Opin Urol 2015; 25:153-7. [PMID: 25581539 DOI: 10.1097/mou.0000000000000141] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Transurethral surgery is an art unique to urologists; mastering the craft is essential for day-to-day practice. Medical treatment along with minimally invasive treatments have significantly reduced the number of transurethral resection of prostates. Decrease in resident's training hours, expanding subspecialties and the emergence of newer technologies have burdened the trainees who are trying to digest the ever-expanding medical literature. Moreover, expectations from patients and insurance companies with a stress on cutting costs and raising litigations have brought changes in apprentice-based to simulator-based training. We studied the role of transurethral resection of prostate simulators in training of transurethral surgery. RECENT FINDINGS TURP simulators from bench to virtual reality computer models are available. Most of them have undergone face, content and construct validity. Nontechnical skills training is also important hence simulation to simulator training. Simulation programmes incorporating communication, team building, minimizing errors caused by distraction and managing complex situations can turn a novice into an expert with adequate practice in a stress-free environment. Work is also done to define learning curve, and factors affecting the path to reach the desired goal. Concepts are emerging to integrate simulators and simulation into the existing training programmes. SUMMARY TURP simulators are essential for training in transurethral surgery. Low or high-fidelity simulators do not matter, but having a well structured simulation programme, under the scrutiny of a dedicated trained faculty, will address most of the issues related to training in transurethral surgery, an art essential for urologists irrespective of the subspecialty one pursues in the future.
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Preece R. The current role of simulation in urological training. Cent European J Urol 2015; 68:207-11. [PMID: 26251745 PMCID: PMC4526607 DOI: 10.5173/ceju.2015.522] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 01/29/2015] [Accepted: 02/20/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction Simulation is becoming an increasingly popular educational tool in numerous surgical specialities, including urology. This article reviews the current role of urological simulators; discussing their need, availability, incorporation and current limitations. Material and methods A literature review of the electronic databases Medline, Embase and Google Scholar was performed. Results For increasingly limited urological training programs, simulation can act as a valuable adjunct to clinical training. Evidence suggests that simulation enables the trainee to bypass the early, error-prone part of the surgical learning curve. It should be incorporated into proficiency-based curricula, with junior trainees initially beginning with low fidelity simulators to grasp basic surgical skills before moving onto full-procedural simulation as they progress through their training. A wide variety of simulators of differing fidelity are currently available, teaching both technical (eg. cystoscopy) and non-technical (eg. communication) urological surgical skills. Whist numerous studies have assessed the face, content and construct validity of various urological simulators, further work needs to be undertaken to determine whether the skills learnt actually improve trainee performance in the operating room. Then, educators will be able to make informed decisions about whether these resource demanding (financially and in terms of demands on faculty) simulators are a worthwhile educational tool. Conclusions Although further investigation is required, urological simulators appear to have a considerable role for developing both technical and non-technical urological skills in an increasingly restricted educational environment in modern urogynecology.
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Affiliation(s)
- Ryan Preece
- Cardiff University School of Medicine, Department of Urology, Cardiff, United Kingdom
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Healy SE, Rai BP, Biyani CS, Eisma R, Soames RW, Nabi G. Thiel Embalming Method for Cadaver Preservation: A Review of New Training Model for Urologic Skills Training. Urology 2015; 85:499-504. [DOI: 10.1016/j.urology.2014.11.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 11/06/2014] [Accepted: 11/13/2014] [Indexed: 12/01/2022]
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Brunckhorst O, Aydin A, Abboudi H, Sahai A, Khan MS, Dasgupta P, Ahmed K. Simulation-based ureteroscopy training: a systematic review. JOURNAL OF SURGICAL EDUCATION 2015; 72:135-143. [PMID: 25130385 DOI: 10.1016/j.jsurg.2014.07.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 06/16/2014] [Accepted: 07/03/2014] [Indexed: 06/03/2023]
Abstract
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.
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Affiliation(s)
- Oliver Brunckhorst
- MRC 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
| | - Abdullatif Aydin
- MRC 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
| | - Hamid Abboudi
- MRC 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
| | - Arun Sahai
- MRC 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
| | - Muhammad Shamim Khan
- MRC 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
| | - Prokar Dasgupta
- MRC 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
| | - Kamran Ahmed
- MRC 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.
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Liu M, Curet M. A review of training research and virtual reality simulators for the da Vinci surgical system. TEACHING AND LEARNING IN MEDICINE 2015; 27:12-26. [PMID: 25584468 DOI: 10.1080/10401334.2014.979181] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED PHENOMENON: Virtual reality simulators are the subject of several recent studies of skills training for robot-assisted surgery. Yet no consensus exists regarding what a core skill set comprises or how to measure skill performance. Defining a core skill set and relevant metrics would help surgical educators evaluate different simulators. APPROACH This review draws from published research to propose a core technical skill set for using the da Vinci surgeon console. Publications on three commercial simulators were used to evaluate the simulators' content addressing these skills and associated metrics. FINDINGS An analysis of published research suggests that a core technical skill set for operating the surgeon console includes bimanual wristed manipulation, camera control, master clutching to manage hand position, use of third instrument arm, activating energy sources, appropriate depth perception, and awareness of forces applied by instruments. Validity studies of three commercial virtual reality simulators for robot-assisted surgery suggest that all three have comparable content and metrics. However, none have comprehensive content and metrics for all core skills. INSIGHTS: Virtual reality simulation remains a promising tool to support skill training for robot-assisted surgery, yet existing commercial simulator content is inadequate for performing and assessing a comprehensive basic skill set. The results of this evaluation help identify opportunities and challenges that exist for future developments in virtual reality simulation for robot-assisted surgery. Specifically, the inclusion of educational experts in the development cycle alongside clinical and technological experts is recommended.
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Affiliation(s)
- May Liu
- a Medical Research Department , Intuitive Surgical, Inc. , Sunnyvale , California , USA
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26
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Geraghty A, Reid S, McIlhenny C. Examining patient safety attitudes among urology trainees. BJU Int 2014; 113:167-75. [PMID: 24053554 DOI: 10.1111/bju.12268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To identify current attitudes to patient safety among urology trainees. To examine whether these have changed with the recent increase in emphasis on patient safety and the introduction of new working procedures in operating theatres. SUBJECTS AND METHODS Subjects included 28 urology trainees, based in the West of Scotland, UK. Trainee attitudes were examined using the Operating Room Management Attitudes Questionnaire, a validated tool for examining attitudes towards patient safety. RESULTS Attitudes to teamwork were highly positive, with 89-100% of trainees acknowledging the need to share information and conduct pre- and postoperative briefs, and 82-96% being accepting of multidisciplinary feedback on performance. Attitudes to preoperative briefing and multidisciplinary feedback were improved compared with a similar historical cohort. Trainees were reluctant to acknowledge the effect of stress and fatigue on personal performance; 50% felt they worked effectively in critical phases of operations even when tired, only 50% would tell team members their workload was becoming excessive and only 36% of trainees recognized that personal problems could affect their performance. There was no significant change in these attitudes from 2006 data. Regarding leadership and confidence assertion, 68% of trainees felt that leadership in the operating theatre should rest with the medical staff, 18% stated senior decisions or actions should not be questioned unless they threaten safety and 7% that they should not be questioned at all. This was similar to previous data. CONCLUSIONS Attitudes to briefing and multidisciplinary feedback appear to have improved since the introduction of the World Health Organization surgical checklist and wider use of feedback tools; other safety attitudes remain largely unchanged. Urology trainees may benefit from further training to better understand the mechanisms of error development, to raise awareness of human performance limitation, particularly the effects of stress and fatigue, and to develop techniques to challenge decisions/respond to challenges.
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Affiliation(s)
- Alistair Geraghty
- Scottish Clinical Simulation Centre, Forth Valley Royal Hospital, Larbert, UK
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Gonzalez CM, McKenna P. Challenges Facing Academic Urology Training Programs: An Impending Crisis. Urology 2013; 81:475-9. [DOI: 10.1016/j.urology.2012.12.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 11/27/2012] [Accepted: 12/02/2012] [Indexed: 11/17/2022]
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Bidarkar SS, Wood J, Cohen RC, Holland AJA. Role of simulation for paediatric proceduralists: practice makes perfect or trial and error? J Paediatr Child Health 2013; 49:94-8. [PMID: 23253077 DOI: 10.1111/jpc.12039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2012] [Indexed: 01/22/2023]
Affiliation(s)
- Sandeep S Bidarkar
- Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Sevdalis N, Hull L, Birnbach D. Improving patient safety in the operating theatre and perioperative care: obstacles, interventions, and priorities for accelerating progress. Br J Anaesth 2012; 109 Suppl 1:i3-i16. [DOI: 10.1093/bja/aes391] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
The reduction in time for training at the workplace has created a challenge for the traditional apprenticeship model of training. Simulation offers the opportunity for repeated practice in a safe and controlled environment, focusing on trainees and tailored to their needs. Recent technological advances have led to the development of various simulators, which have already been introduced in surgical training. The complexity and fidelity of the available simulators vary, therefore depending on our recourses we should select the appropriate simulator for the task or skill we want to teach. Educational theory informs us about the importance of context in professional learning. Simulation should therefore recreate the clinical environment and its complexity. Contemporary approaches to simulation have introduced novel ideas for teaching teamwork, communication skills and professionalism. In order for simulation-based training to be successful, simulators have to be validated appropriately and integrated in a training curriculum. Within a surgical curriculum, trainees should have protected time for simulation-based training, under appropriate supervision. Simulation-based surgical education should allow the appropriate practice of technical skills without ignoring the clinical context and must strike an adequate balance between the simulation environment and simulators.
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31
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Møller TP, Østergaard D, Lippert A. Facts and fiction – Training in centres or in situ. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2012. [DOI: 10.1016/j.tacc.2012.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Schlickum M, Felländer-Tsai L, Hedman L, Henningsohn L. Endourological simulator performance in female but not male medical students predicts written examination results in basic surgery. Scand J Urol 2012; 47:38-42. [PMID: 23323791 PMCID: PMC3549609 DOI: 10.3109/00365599.2012.693538] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
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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Affiliation(s)
- Marcus Schlickum
- Division of Orthopedics, Institution for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Cruz JASD, Passerotti CC, Frati RMC, Reis STD, Okano MTR, Gouveia ÉM, Biolo KD, Duarte RJ, Nguyen H, Srougi M. Surgical Performance During Laparoscopic Radical Nephrectomy Is Improved With Training in a Porcine Model. J Endourol 2012; 26:278-82. [DOI: 10.1089/end.2011.0367] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Carlo Camargo Passerotti
- Department of Urology, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
- Urology Department, College of Medicine, Nove de Julho University (UNINOVE), São Paulo, Brazil
| | | | | | | | - Éder Maxwell Gouveia
- Department of Urology, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Karlo Dornelles Biolo
- Department of Urology, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Ricardo Jordão Duarte
- Department of Urology, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Hiep Nguyen
- Department of Urology, Children's Hospital, Boston, Harvard Medical School, Boston, Massachusetts
| | - Miguel Srougi
- Department of Urology, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
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Current world literature. Curr Opin Urol 2012; 22:160-5. [PMID: 22297787 DOI: 10.1097/mou.0b013e328350f678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Forster JA, Browning AJ, Paul AB, Biyani CS. Surgical simulators in urological training - views of UK Training Programme Directors. BJU Int 2012; 110:776-8. [DOI: 10.1111/j.1464-410x.2011.10865.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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36
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Abbas F, Coburn M. Education and Training of an Academic Urologic Surgeon. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Current world literature. Curr Opin Urol 2011; 22:78-82. [PMID: 22143440 DOI: 10.1097/mou.0b013e32834ec873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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