Education, Simulation & Virtual Reality
Moderated Poster Session
MP19-15 - Development and Validation of a Modular Training and Assessment Score for Percutaneous Nephrolithotomy
Saturday, September 22
2:00 PM - 4:00 PM
Location: Room 241
Division of Transplantation, Immunology & Mucosal Biology, Faculty of Life Sciences & Medicine, King's College London, Guy's Campus, London, England, SE1 1UL, United Kingdom
Abdullatif Aydin, BSc, MBBS
The Urology Foundation Simulation Research Fellow
MRC Centre for Transplantation, Guy's Hospital, King's College London
University of Medicine and Pharmacy Victor Babes, Timisoara, Romania
Professor of Urology
Kafkas University, Faculty of Medicine, Urology Department
Medical University of Vienna, Urology, Vienna, Austria
National and Kapodistrian, University of Athens, Athens, Greece
Guohua Zeng, MD
The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
Department of Urology, Guy's and St. Thomas' NHS Foundation Trust
MRC Centre for Transplantation, King's College London
Introduction & Objective : Percutaneous nephrolithotomy (PCNL) remains the first line of treatment for large renal calculi and is considered a technically challenging procedure with multiple steps for urological trainees to learn. To ensure good patient outcomes and decrease the number of adverse events, it is important to standardise training through the creation of a procedure-specific curriculum. The aim of this study was to develop, and content validate an assessment tool for PCNL, taking into consideration the procedure specific risks.
Methods : This longitudinal, observational and prospective international study utilised healthcare failure mode and effect analysis (HFMEA), which was applied to PCNL to develop a final assessment tool. The procedure was systematically mapped out and failure modes for each step of the technique were outlined. 6 surgeons were observed across 3 hospitals for 22.5 hours. Hazard analysis scoring was conducted by 11 urolithiasis experts based on predefined severity and probability scores. The most hazardous stages of PCNL were highlighted. It was determined if the steps were single point weaknesses of the procedure, detectable or if there was an existing control measure in place to prevent the failure mode. Single point weaknesses and those assigned a hazard score > 4 were included in the PCNL assessment tool. The tool was subsequently content validated by 16 experts from 10 countries.
Results : Application of HFMEA identified 64 failure modes; 37 failure modes had a hazard score ≥ 4. After adaptations based on expert feedback the final PCNL Assessment Score was developed. The PCNL Assessment Score contains 10 phases, 21 processes and 47 sub-processes. The phases include: pre-operative preparation, cystoscopy and ureteric catheterisation, patient positioning and stone identification, needle and guidewire insertion, tract dilatation and nephroscope insertion, stone fragmentation, stone extraction, stent insertion and instrument removal, tube insertion and finalising and handover. All participants agreed that the final PCNL Assessment Score contained the most important steps.
Conclusions : As a result of development and content validation, the PCNL assessment tool can be utilised in conjunction with e – learning, non-technical surgical skills and simulation to form a complete PCNL curriculum for urological trainees.