LBA01-05: Simulation in Urological Training and Education (SIMULATE): An International Randomised Controlled Clinical and Educational Trial to Determine the Effect of Simulation-based Surgical Training
Friday, May 15, 2020
7:00 AM – 9:00 AM
Abdullatif Aydin, Kamran Ahmed, Mieke Van Hemelrijck, Hashim Ahmed, Takashige Abe, Wei Zhu, John Sfakianos, Ali Serdar Gözen, Thomas Kunit, Andreas Skolarikos, Nicholas Raison, Felix Moltzahn, Thomas Knoll, Andrea Lantz, Ahmed Al-Jabir, Oliver Brunckhorst, Ben Chew, George Thalmann, Jens Rassweiler, Nobuo Shinohara, Mantu Gupta, Ashutosh Tewari, Guohua Zeng, Muhammad Shamim Khan, Prokar Dasgupta
Introduction: Simulation in Urological Training and Education (SIMULATE): An International Randomised Controlled Clinical and Educational Trial to Determine the Effect of Simulation-based Surgical Training
Methods: This international, multicentre randomised controlled superiority trial recruited urology trainees (n=94) who had performed =10 ureterorenoscopy (URS) cases, as a selected index procedure, with no prior simulation experience. Recruits were randomised to simulation-based training (SBT) or non-simulation-based training (NSBT) groups, the latter of which is the current standard of training. Training sessions were conducted for the SBT arm, utilising an expert-developed training curriculum. The primary outcome was the number of procedures required to achieve proficiency, defined as achieving an OSATS score of =28 on 3 consecutive operations, without complications. Secondary outcomes included number of surgical complications and stone-free status in each arm. All participants were followed up for 25 procedures or over 18 months.
Results: A total of 65 participants continued follow-up from the SBT (n=32) and NSBT (n=33) arms, performing a total of 1140 procedures (593 vs 547). Proficiency was reached in 21 SBT and 18 NSBT participants (OR: 1.59 [95% CI 0.59-4.33]) over 9.6 and 10.9 sessions (HR: 1.41 [95% CI 0.72-2.75]), respectively. Sub-analysis for semi-rigid URS demonstrated proficiency in 19 SBT and 16 NSBT participants (p=0.38) over 7.8 vs 9.9 sessions. In flexible URS, 20 SBT and 9 NSBT participants reached proficiency (p=0.04) over 8.1 vs 7.3 sessions. The SBT group scored =28 (OSATS) in 310 (52.3%) cases in comparison to 234 (42.8%) in the NSBT group (p<0.0001). In total, 15 vs 36 surgical complications were reported (p=0.15), with fewer Grade =3 Clavien-Dindo seen in the SBT (n=3) group compared to NSBT (n=9). Fewer non-stone-free patients were observed (p=0.87) in SBT (n=39) than NSBT (n=50).
Conclusions: There was no statistical significance in the overall number of procedures required to reach proficiency between the two groups. However, fewer complications, better clinical outcomes, and a higher number of participants reaching proficiency in flexible URS indicate a positive trend in favour of SBT and affirm the role of simulation training for more complex procedures; (ISCRTN 12260261). Source of
