Education, Simulation & Virtual Reality

Moderated Poster Session

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

Saturday, September 22
2:00 PM - 4:00 PM
Location: Room 241

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

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    Kamran Ahmed

    MRC Centre for Transplantation, King's College London

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      Nicholas Raison

      MRC Centre for Transplantation, King's College London

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        Takashige Abe

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

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          Ahmed Al-Jabir

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

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            Thomas Kunit

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              Ali Gözen

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                Jens Rassweiler

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                  Thomas Knoll

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

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                    Felix Moltzahn

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                      George Thalmann

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                        Andreas Skolarikos

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

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                          Nobuo Shinohara

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

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                            Guohua Zeng

                            Vice Director
                            The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

                            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.

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                              Andrea Lantz

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                                Ben H. Chew

                                Associate Professor, Department of Urologic Sciences
                                University of British Columbia

                                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 (www.endoedge.net) 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.

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                                  John Sfakianos

                                  Assistant Professor of Urology
                                  Icahn School of Medicine at Mount Sinai

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                                    Mantu Gupta

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

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                                      Shamim Khan

                                      Consultant
                                      Department of Urology, Guy's and St. Thomas' NHS Foundation Trust

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                                        Prokar Dasgupta

                                        MRC Centre for Transplantation, King's College London

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