SURGICAL SKILLS EDUCATION IN UROLOGY DOES IT MATTER? Conflict of - PowerPoint PPT Presentation

Jeff McKay Scott Bagnell SURGICAL SKILLS EDUCATION IN UROLOGY – DOES IT MATTER?

Conflict of Interest Statement No conflict of interests to state

Outline Definitions 1. Do we need surgical simulation? Why? 2. Types of surgical simulation in urology 3. Strengths/weaknesses of simulation 4. Implementing simulation curriculum into 5. residency program

Outline Definitions 1. Do we need surgical simulation? Why? 2. Types of surgical simulation in urology 3. Strengths/weaknesses of simulation 4. Implementing simulation curriculum into 5. residency program

Definitions Simulator Device that enables operator to reproduce or represent test conditions or phenomena likely to occur in actual performance Fidelity How “realistic” is the simulator Low or High-fidelity Merrium-Webster Online Dictionary. Avail at www.merrium- webster.com

Fidelity Low fidelity ureteroscopy trainer High fidelity ureteroscopy trainer Matsumoto et al. The effect of bench model fidelity on endourological skills: a randomized controlled study. J Urol 2002. 1243-1247

Definitions Virtual Reality Artificial environment which is experienced through sensory stimuli provided by a computer and in which one’s actions partially demonstrate what happens in the environment Merrium-Webster Online Dictionary. Avail at www.merrium- webster.com

Virtual Reality simulators

VALIDATION Validity Instrument appropriately measures what it was intended to measure Subjective and objective benchmarks Wignall et al. Surgical simulation: a urological perspective. J Urol 2008. 179; 1690-1699

Subjective Validity Assessment Face validity Test seems reasonable and appropriate Content validity Assures contents of test cover relevant areas Wignall et al. Surgical simulation: a urological perspective. J Urol 2008. 179; 1690-1699

Objective Validity Assessment Criterion validity Correlation of results of tool with established tool Predictive validity - Extent which scores on new test predict future clinical performance Construct validity Used if no clear standard exists for comparison Wignall et al. Surgical simulation: a urological perspective. J Urol 2008. 179; 1690-1699

Objective Structured Assessment of Technical Skills Examination Best measure of operative performance Checklists & global rating scales for evaluation of tasks Few simulators have undergone rigorous tests that would fully validate use for training or proficiency assessment Wignall et al. Surgical simulation: a urological perspective. J Urol 2008. 179; 1690-1699

Outline Definitions 1. Do we need surgical simulation? Why? 2. Types of surgical simulation in urology 3. Strengths/weaknesses of simulation 4. Implementing simulation curriculum into 5. residency program

Need for Surgical Simulation in Urology Decreasing opportunities for residents to learn in OR Limited work hours Financial constraints – surgical efficiency Fear of litigation Increasingly complex cases Practising surgeons often learning new skills *Anastakis et al. Evaluating the effectiveness of a 2-year curriculum in surgical skills center . Am J Surg 2003; 185: 378

Barriers to Surgical Simulation Small market Few simulators validated for teaching High cost of software design High cost of simulators at centres Selecting and retaining suitable faculty 1. Wignall et al. Surgical Simulation: A Urological Perspective. J Urol 2007 2. Forster et al. Surgical simulators in urological training – views of UK training programme directors BJU Int 2011.

Outline Definitions 1. Do we need surgical simulation? Why? 2. Types of surgical simulation in urology 3. Strengths/weaknesses of simulation 4. Implementing simulation curriculum into 5. residency program

Types of Surgical Simulation in Urology Cystoscopy Ureteroscopy TURP/TURBT PCNL with Renal Access Laparoscopy Robotics

Types of Surgical Simulation in Urology Cystoscopy Ureteroscopy TURP/TURBT PCNL with Renal Access Laparoscopy Robotics

Cystoscopy – Surgical simulation Schout et al. Transfer of cysto-urethroscopy skills from virtual-reality simulator to the operating room. A randomized control trial. BJU Int 2009

Cystoscopy – surgical simulation 100 interns randomized Schout et al. Transfer of cysto-urethroscopy skills from virtual-reality simulator to the operating room. A randomized control trial. BJU Int 2009

Cystoscopy – surgical simulation Schout et al. Transfer of cysto-urethroscopy skills from virtual-reality simulator to the operating room. A randomized control trial. BJU Int 2009

Cystoscopy – surgical simulation Schout et al. Transfer of cysto-urethroscopy skills from virtual-reality simulator to the operating room. A randomized control trial. BJU Int 2009

Cystoscopy – Surgical simulation Conclusion Interns who trained on UroMentor outperformed controls Schout et al. Transfer of cysto-urethroscopy skills from virtual-reality simulator to the operating room. A randomized control trial. BJU Int 2009

Types of Surgical Simulation in Urology Cystoscopy Ureteroscopy TURP/TURBT PCNL with Renal Access Laparoscopy Robotics

Ureteroscopy – surgical simulation

Ureteroscopy – surgical simulation Research QUESTION: Does bench model fidelity affect surgical skills? 40 4 th year med students randomized to: 1. Didactic session (7) 2. Low fidelity bench model practice (16) 3. High fidelity bench model practice (17) Matsumoto et al. The effect of bench model fidelity on endourological skills: a randomized controlled study. J Urol 2002. 1243-1247

Ureteroscopy – Surgical Simulation Matsumoto et al. The effect of bench model fidelity on endourological skills: a randomized controlled study. J Urol 2002. 1243-1247

Ureteroscopy – surgical simulation Conclusion: Low-fidelity and high-fidelity significantly improved GRS 1. and pass rate Low fidelity had similar results to high fidelity at a much 2. cheaper cost Matsumoto et al. The effect of bench model fidelity on endourological skills: a randomized controlled study. J Urol 2002. 1243-1247

Ureteroscopy – surgical simulation 20 2 nd year medical students randomized to: 1. Control (untrained) group 2. Test (trained) group Watterson et al. A randomized, prospective blinded study validating the acquisition of ureteroscopy skills using a computer based virtual reality endourological simulator . J Urol 2002

URO Mentor – VR Simulation Watterson et al. A randomized, prospective blinded study validating the acquisition of ureteroscopy skills using a computer based virtual reality endourological simulator . J Urol 2002

Results Watterson et al. A randomized, prospective blinded study validating the acquisition of ureteroscopy skills using a computer based virtual reality endourological simulator . J Urol 2002

Ureteroscopy – surgical simulation Established: Face validity Content validity Not established Criterion validity Watterson et al. A randomized, prospective blinded study validating the acquisition of ureteroscopy skills using a computer based virtual reality endourological simulator . J Urol 2002

Ureteroscopy – surgical simulation 16 Urology residents assessed on basket extraction of distal ureteric stone using UroMentor VR simulator Performance on VR simulator compared to high fidelity bench model (UroScopic Trainer) Matsumodo et al. Virtual reality ureteroscopy simulator as a valid tool for assessing endourological skills. Int J Urol . 2006.

VR simulator vs high fidelity bench model

Results Results of VR Simulator Correlation with performance on high fidelity bench model from previous study Matsumodo et al. Virtual reality ureteroscopy simulator as a valid tool for assessing endourological skills. Int J Urol . 2006.

Conclusions UroMentor is a useful tool for the assessment of resident performance Predictive validity and content validity as performance correlated with UroScopic trainer Future studies needed to correlate performance in the OR Matsumodo et al. Virtual reality ureteroscopy simulator as a valid tool for assessing endourological skills. Int J Urol . 2006.

Types of Surgical Simulation in Urology Cystoscopy Ureteroscopy TURP/TURBT PCNL with Renal Access Laparoscopy Robotics

TURP – Surgical Simulation URO-Trainer VR simulator SurgicalSIM TURP simulator

Simbionix TURP trainer

TURP – Surgical Simulation • Version 1.0 of VR based TURP simulator • 72 board certified urologists • 19 novices Participants: • Completed pre-task questionnaire • Viewed training video • Performed pre-compiled 5-minute resection task

Results Sweet et al. Face, content and construct validity of the University of Washington virtual reality transurethral prostate resection trainer. J Urol 2004; 172: 1953-1957

Conclusions Face, content, construct validity for v1.0 of Univ of Washington TURP Simulator Need predictive validity study to complete validation Integration of simulator into training is appropriate Not validated for assessment until more rigorous validation complete Sweet et al. Face, content and construct validity of the University of Washington virtual reality transurethral prostate resection trainer. J Urol 2004; 172: 1953-1957

TURBT Simulation 24 medical students 12 residents in urology