Category: Education, Simulation & Virtual Reality

MP19-2 - The SIMULATE Ureterorenoscopy Training Curriculum: An International Multicentre Validation Study

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective :

There have been considerable developments and subsequent use of virtual reality (VR), bench and wet-lab simulation models in urology. However, utilising different modalities within a curriculum is suggested to be much more effective. Furthermore, increasing emphasis has also been placed on training non-technical skills. The international SIMULATE curriculum for ureterorenoscopy (URS) employs the most evidence-based validated training models, in a structured fashion. The aim of this study is to assess the validity of the SIMULATE URS training curriculum.

Methods :

Junior residents with less than 10 URS experience (n=46) were invited for training using the curriculum on ve separate occasions in Manchester (n=15), Salzburg (n=15), Hokkaido (n=5), Guangzhou (n=9) and London (n=4). Participants performed cases on the URO Mentor VR simulator (Simbionix) and also the Uro-Scopic Trainer (Limbs & Things) and Advanced Scope Trainer (Mediskills) bench models. The rst cohort was also given the opportunity to use fresh frozen cadavers with uoroscopy. Performances were evaluated through the sessions using OSATS, by endourology and education specialists, all of whom were also invited for an evaluation survey following training. Construct validity was assessed using a One-way ANOVA test to evaluate the level of progress throughout the curriculum.

Results :

Participants rated that the training signi cantly improved their skills (mean: 4.2/5) and that they gained transferrable skills (mean: 4.2/5). A One-way ANOVA test of overall progress through the training curriculum revealed signi cant improvement (p=0.0007) in both semi-rigid (p=0.0032) and exible URS (p=0.0003). Of the utilised modalities, exible URS (mean: 4.3/5) and stone fragmentation (mean: 4.3/5) were rated to be the strongest aspects of the Uro Mentor VR simulator. In contrast, 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). Furthermore, there was no difference in OR performance between the cadaveric (n=9) and non-cadaveric groups (n=12; p=0.6872).

Conclusions :

The international SIMULATE URS curriculum demonstrated content and construct validity. Participants are currently being followed up in the OR for 25 procedures, as part of the ongoing SIMULATE randomised controlled trial, and will be compared to the no simulation arm.

Abdullatif Aydin

The Urology Foundation Simulation Research Fellow
MRC Centre for Transplantation, Guy's Hospital, King's College London
London, England, United Kingdom

Kamran Ahmed

MRC Centre for Transplantation, King's College London
London, England, United Kingdom

Nicholas Raison

MRC Centre for Transplantation, King's College London
London, England, United Kingdom

Takashige Abe

Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
Sapporo, Hokkaido, Japan

Ahmed Al-Jabir

Medical student
GKT School of Medical Education, King's College London
London, England, United Kingdom

Thomas Kunit

Salzburg, Salzburg, Austria

Ali Gözen

Heilbronn, Baden-Wurttemberg, Germany

Jens Rassweiler

Heilbronn, Baden-Wurttemberg, Germany

Thomas Knoll

Associate Professor
Department of Urology, Sindelfingen-Boeblingen Medical Center, University of Tuebingen, Germany
Tuebingen, Thuringen, Germany

Felix Moltzahn

Bern, Bern, Switzerland

George Thalmann

Bern, Bern, Switzerland

Andreas Skolarikos

National and Kapodistrian, University of Athens, Athens, Greece
Athens, Attiki, Greece

Nobuo Shinohara

Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
Sapporo, Hokkaido, Japan

Guohua Zeng

Vice Director
The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
Guangzhou, Guangdong, China (People's Republic)

Professor Zeng is currently the Vice- President of The First Affiliated Hospital of Guangzhou Medical University, Chief of Guangdong key lab of Urology and Chief of Guangzhou Urology Research Institute. Director of certified fellowship program by Endourology Society. President of Guangdong provincial urological association, Associate member of EULIS.
He completed his Master of Urology training in 1992, and his PhD in Urology in 2000. Clinical endourology fellowship at UT Southwestern Medical Center at Dallas in 2007. As an experienced endourologist, he has finished more than 12000 endourological procedures including all kinds of PCNLs, rigid URS and RIRS procedures and Uro-laparoscopic procedures. Leading the development of RIRS in China, he and his group perform more than 1000 RIRS per year. Prof. Zeng and his colleagues also created a unique mini-PCNL technique, namely Chinese Mini-PCNL, in which more than 30000 Chinese Mini-PCNLs surgeries has been performed by Prof. Zeng and his team with good clinical outcome. He also invented a new minimally invasive technique in treatment of middle size renal stones, called “Super-Mini-PCNL (SMP)”.Main innovation in SMP technique is irrigation and suction in the same sheath, it totally solve all problems in Mini-perc technique including low irrigation flow, difficulty in removal stone fragements, high intrarenal pressure and so on, SMP technique has the advantages of a good irrigation, fast stone fragements evacuation and lower intrarenal pressure, So SMP technique is a conception revolution for mini-perc technique.
Prof. Zeng has gained 5 research projects for stone disease from National Natural Science Foundation. More than 100 academic papers have been published in national and international journals, 10 books about stone disease have been published.

Andrea Lantz

Halifax, Nova Scotia, Canada

Ben H. Chew

Associate Professor, Department of Urologic Sciences
University of British Columbia
Vancouver, British Columbia, Canada

Dr. Chew is a urologist and the Director of Clinical Research at the Stone Centre at Vancouver General Hospital and an Associate Professor of Urology at the University of British Columbia in Vancouver, Canada. His main interests lie in the treatment and research of the pathophysiology of kidney stone disease. His research focus includes metabolic stone disease as well as biomaterials used in the urinary tract for ureteral stents. He has worked on various stent designs, stent coatings and drug-eluting ureteral stents to try and improve the quality of life for patients with kidney stone disease. He continues work on a degradable ureteral stent and has completed the first-in-human trials. Current studies include attempting to understand second messenger systems that are activated within the kidney and ureter once a ureteral stent has been placed. These could be exploited as future therapeutic targets for new drug eluting ureteral stents or designs to reduce symptoms.
He has authored over 80 peer-reviewed manuscripts and book chapters. He is a member of the Endourologic Disease Group for Excellence (EDGE) research consortium ( and the Wisconsin Quality of Life (WISQoL) research consortium. Dr. Ben Chew is also the Chair of Research for the Endourology Society. The role of the Research Chair is to facilitate and help improve research for the entire society.

John Sfakianos

Assistant Professor of Urology
Icahn School of Medicine at Mount Sinai
New York, New York

Mantu Gupta

Chairman of Urology
Mount Sinai West and Mount Sinai St. Luke's
New York, New York

Shamim Khan

Department of Urology, Guy's and St. Thomas' NHS Foundation Trust
London, England, United Kingdom

Prokar Dasgupta

MRC Centre for Transplantation, King's College London
London, England, United Kingdom