Abstract: PD41-03
Sources of Funding: SIMULATE is primarily funded by The Urology Foundation. The authors are most grateful for support from the following companies: Coloplast, Olympus, Karl Storz, Boston Scientific, ProMed, Simbionix, Limbs and Things, and Mediskilss, without whom the delivery of the educational program would not be possible. KA and PDG also acknowledge support from the NIHR Biomedical Research Centre and MRC Centre for Transplantation, King’s Health Partners.

Introduction

Recent developments in surgical education suggest that training using a range of simulators of different modalities, within a curriculum, may be much more effective. Furthermore, emphasis must also be placed on nontechnical skills training. The aim of this study is to assess the face, content, construct and transfer components of validity of the newly-developed SIMULATE ureterorenoscopy (URS) training curriculum.

Methods

A comprehensive training curriculum was developed by experts (n=21) and residents (n=25) using the Delphi process. The curriculum consists of virtual reality, dry-lab and full immersion simulation modalities. Upon completion, 30 residents were invited for training using the curriculum on two separate occasions in the UK (n=15) and Austria (n=15). The former cohort were also given the opportunity to use fresh frozen cadavers with fluoroscopy. Participants were taught and assessed, using OSATS, by endourology and education specialists, all of whom were also invited for an evaluation survey following the training program. Construct validity was assessed using a One-way ANOVA test to evaluate the level of progress throughout the training. Residents were followed up at their institutions and assessed for technical skills, using OSATS, and nontechnical skills, using a modified NOTSS score for URS on their first (n=12) and fourth (n=11) cases to evaluate transfer validity.

Results

Participants rated that the training significantly improved their skills (mean: 4.2/5) and that they gained transferrable skills (mean: 4.2/5). A One-way ANOVA test revealed significant improvement in both semi-rigid URS (p<0.0001) and flexible URS (p=0.0003) skills, with consecutive cases throughout the course of the curriculum and the first operating room performance (n=12). Statistically significant improvement was observed in non-technical skills from between the training and first operating room performance (p<0.0001). Of the used modalities, flexible URS (mean: 4.3/5) and stone fragmentation (mean: 4.3/5) were rated to be the strongest aspects of the UroMentor. In contrast, both the dry-lab models scored the highest with regards to instrument handling, laser stone fragmentation and stone extraction. C-arm control was the most highly rated aspect of fresh frozen cadavers (mean: 4.7/5).

Conclusions

The SIMULATE URS curriculum revealed face, content, construct and validity. Participants are currently being followed up in the operating room for 25 URS procedures and will compared to an arm with no simulation experience, as part of the on-going SIMULATE randomised controlled trial.

Funding

SIMULATE is primarily funded by The Urology Foundation. The authors are most grateful for support from the following companies: Coloplast, Olympus, Karl Storz, Boston Scientific, ProMed, Simbionix, Limbs and Things, and Mediskilss, without whom the delivery of the educational program would not be possible. KA and PDG also acknowledge support from the NIHR Biomedical Research Centre and MRC Centre for Transplantation, King’s Health Partners.