Competency-Based Training and Simulation: Making a "Valid" Argument.

The use of simulation as an assessment tool is much more controversial than is its utility as an educational tool. However, without valid simulation-based assessment tools, the ability to objectively assess technical skill competencies in a competency-based medical education framework will remain challenging. The current literature in urologic simulation-based training and assessment uses a definition and framework of validity that is now outdated.

Optimizing the Timing of Expert Feedback During Simulation-Based Spaced Practice of Endourologic Skills.

Introduction: Provision of expert feedback is widely acknowledged to be an essential component of simulation-based training. However, little is known about the most effective and efficient ways to provide feedback to novices. Optimizing the timing of expert feedback may improve outcomes while reducing resource requirements.

Anthropometric Renal Anatomic Alterations Between Supine and Prone Positions in Percutaneous Renal Ablation for Renal Cortical Neoplasms.

Objectives: To establish patterns of anatomic changes relevant to the kidney and colon during positional change between the supine and prone positions as noted on CT scans performed during percutaneous cryoablation for renal cortical neoplasms (RCN).

Methods: Nineteen patients undergoing percutaneous cryoablation for RCN with abdominal CT scan in both the supine and prone positions were included in the study. We documented the anterior/posterior, medial/lateral, and cranial/caudal anatomic changes of the kidney, kidney rotation, and the proportion of the kidney whose access was limited by the liver, spleen, and lung.

Development of a novel iPad-based laparoscopic trainer and comparison with a standard laparoscopic trainer for basic laparoscopic skills testing.

Introduction: We developed the iTrainer (iT) as a portable laparoscopic trainer, which incorporates the iPad tablet. We then compared the iT with a standard pelvic trainer (SPT) to assess surgical skills as well as its image quality, resolution, brightness, comfort, and overall performance.

Materials And Methods: We designed and constructed the iT to be compatible with the Apple iPad 3 and standard laparoscopic instruments.

Evaluation of the impact of three-dimensional vision on laparoscopic performance.

Introduction: Recent technological advancements have led to the introduction of new three-dimensional (3D) cameras in laparoscopic surgery. The 3D view has been touted as useful during robotic surgery, however, there has been limited investigation into the utility of 3D in laparoscopy.

Materials And Methods: We performed a prospective, randomized crossover trial comparing a 0° 3D camera with a conventional 0° two-dimensional (2D) camera using a high definition monitor (Karl Storz, Tuttlingen, Germany).

High-fidelity simulation-based team training in urology: evaluation of technical and nontechnical skills of urology residents during laparoscopic partial nephrectomy.

Introduction: The use of low-risk simulation training for resident education is rapidly expanding as teaching centers integrate simulation-based team training (SBTT) sessions into their education curriculum. SBTT is a valuable tool in technical and communication skills training and assessment for residents. We created a unique SBTT scenario for urology residents involving a laparoscopic partial nephrectomy procedure.

Evaluation of potential distractors in the urology operating room.

Background And Purpose: Surgical outcomes depend on patient and disease-related factors, as well as the technical skill of the surgeon. Various distractions in the operating room (OR) environment have been shown to negatively impact a surgeon's performance. A survey was conducted with the objective to evaluate and characterize distractions during urologic surgery.

Robotic surgical simulation.

Robotic surgery has undergone exponential growth and has ever developing utilization. The explosion of new technologies and regulation have led to challenges in training surgeons who desire this skill set. We review the current state of robotic simulation and incorporation of simulation into surgical training curricula.

Surgical skills acquisition among left-handed trainees-true inferiority or unfair assessment: a preliminary study.

Introduction: Studies involving the formal assessment of surgical skills have often reported inferior abilities among left-handed surgical trainees (LHT). Most surgical training curricula and assessment methods, however, are inherently geared toward right-handed trainees (RHT); potentially placing LHT at both a training and assessment disadvantage. We evaluated the effect of a hand dominance-based curriculum for acquisition of basic suturing and knot tying skills among medical students.

In vitro evaluation of ScopeSafe fibers and the scope guardian sheath in prevention of ureteroscope endolumenal working damage.

Background And Purpose: Ureteroscope breakage is commonly related to laser fiber damage. Often, the damage is mechanical and not energy related. As such, we evaluated a novel laser fiber and sheath system in preventing mechanical ureteroscope damage during fiber insertion.

Effect of the American Urological Association Annual Review course on the results of the urology qualifying examination.

Purpose: In this study we assess the impact of a urology dedicated review course on the scores of the corresponding board qualifying examination for attendees of the urology review course.

Materials And Methods: The ABU (American Board of Urology) Qualifying Examination scores from 2009, 2010 and 2011 were categorized into group 1 candidates who attended the AUA (American Urological Association) Annual Review Course the same year, and group 2 candidates who did not attend the AUA Annual Review Course that same year, and were compared. The scores of the preceding year's In-Service Examination were also compared for the same groups of candidates and compared to their subsequent first time taken Qualifying Examination scores.

Validation, correlation, and comparison of the da Vinci trainer(™) and the daVinci surgical skills simulator(™) using the Mimic(™) software for urologic robotic surgical education.

Purpose: Virtual reality simulators with self-assessment software may assist novice robotic surgeons to augment direct proctoring in robotic surgical skill acquisition. We compare and correlate the da Vinci Trainer™ (dVT) and da Vinci Surgical Skills Simulators (dVSSS) in subjects with varying robotic experience.

Materials And Methods: Students, urology residents, fellows, and practicing urologists with varying robotic experience were enrolled after local institutional review board approval.

Genitourinary exam skills training curriculum for medical students: a follow-up study of comfort and skill utilization.

Purpose: We developed a genitourinary skills training (GUST) curriculum for incoming third year medical students (MS3) and performed a follow-up study of comfort with and utilization of these skills.

Materials And Methods: GUST consisted of a didactic lecture followed by skills sessions including standardized patient testicular examination (TE) and digital rectal examination (DRE), male and female Foley catheter (MFC and FFC) placement training, suture-knot tying, and a faculty-directed small group learning session. Precourse and postcourse, and 6 and 18 months after the course, MS3 rated comfort with each skill (Likert scale 0-5), and quantified skill usage.

Positive correlation between motion analysis data on the LapMentor virtual reality laparoscopic surgical simulator and the results from videotape assessment of real laparoscopic surgeries.

Purpose: We studied the construct validity of the LapMentor, a virtual reality laparoscopic surgical simulator, and the correlation between the data collected on the LapMentor and the results of video assessment of real laparoscopic surgeries.

Materials And Methods: Ninety-two urologists were tested on basic skill tasks No. 3 (SK3) to No.

Medical students pursuing surgical fields have no greater innate motor dexterity than those pursuing nonsurgical fields.

Introduction: Medical students pursue different career paths based on a variety of factors. We sought to examine the impact of innate manual dexterity, both perceived and objective, on the career interests of medical students.

Methods: Third-year medical students from the University of California, Irvine were recruited for this study.

An in vivo evaluation of a novel spiral cut flexible ureteral stent.

Objective: The flow characteristics, ureteral conformance, and histopathologic changes of a novel spiral cut flexible ureteral stent (Percuflex Helical, Boston Scientific, Boston, MA) were evaluated in vivo in an acute and chronic porcine model.

Materials And Methods: Flow characteristics and ureteral conformance of the novel stent were determined in 6 acute and 6 chronic swine models and compared with a control ureteral stent (Percuflex Plus, Boston Scientific). The flow characteristics were determined in vivo after ligating the renal vessels and via a nephrostomy tube delivering a standard rate of 0.

High fidelity simulation based team training in urology: a preliminary interdisciplinary study of technical and nontechnical skills in laparoscopic complications management.

Purpose: Simulation based team training provides an opportunity to develop interdisciplinary communication skills and address potential medical errors in a high fidelity, low stakes environment. We evaluated the implementation of a novel simulation based team training scenario and assessed the technical and nontechnical performance of urology and anesthesiology residents.

Materials And Methods: Urology residents were randomly paired with anesthesiology residents to participate in a simulation based team training scenario involving the management of 2 scripted critical events during laparoscopic radical nephrectomy, including the vasovagal response to pneumoperitoneum and renal vein injury during hilar dissection.

Validation study of a virtual reality robotic simulator--role as an assessment tool?

Purpose: Virtual reality simulators are often used for surgical skill training since they facilitate deliberate practice in a controlled, low stakes environment. However, to be considered for assessment purposes rigorous construct and criterion validity must be demonstrated. We performed face, content, construct and concurrent validity testing of the dV-Trainer™ robotic surgical simulator.

Are multiple cryoprobes additive or synergistic in renal cryotherapy?

Objective: To investigate the relationship between multiple cryoprobes was investigated to determine whether they work in an additive or synergistic fashion in an in vivo animal model because 1.47 mm (17-gauge) cryoprobes have been introduced to the armamentarium for renal cryotherapy.

Methods: Laparoscopic-guided percutaneous cryoablation was performed in both renal poles of 3 pigs using 3 IceRod cryoprobes.