Skip to main content

Advertisement

SpringerLink
Log in

Is there a place for virtual reality simulators in assessment of competency in percutaneous renal access?

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Objective

To assess competency of urology post-graduate trainees (PGTs) in percutaneous renal access (PCA).

Methods

Upon obtaining ethics approval and informed consents, PGTs between post-graduate years (PGY-3 to PGY-5) from all four urology programs in Québec were recruited. PCA competency of each participant was assessed objectively by performing task 4 on the PERC Mentor™ simulator, where they had to correctly access and pop 7 balloons in 7 different renal calyces and subjectively by the validated Percutaneous Nephrolithotomy—Global Rating Scale (PCNL-GRS).

Results

A total of 26 PGTs with a mean age of 29.2 ± 0.7 years participated in this study. When compared with the 21 PGTs without practice, all 5 PGTs who had practiced on the simulator were competent (p = 0.03), performed the task with significantly shorter operative time (13.9 ± 0.7 vs. 4.4 ± 0.4 min; p < 0.001) and fluoroscopy time (9.3 ± 0.6 vs. 3.4 ± 0.4 min; p < 0.001), and had significantly higher PCNL-GRS scores (13 ± 0.6 vs. 20.6 ± 1; p < 0.001) and successful attempts to access renal calyces (23 ± 5 vs. 68.7 ± 11; p = 0.001). According to a pass score of 13/25, thirteen PGTs were competent. Competent PGTs performed the task with significantly shorter fluoroscopy time (9.8 vs. 6.5 min; p = 0.01) and higher percentage of successful attempts to access renal calyces (p < 0.001), higher PCNL-GRS scores (p < 0.001), and lower complications (p = 0.01).

Conclusion

The PCNL-GRS in combination with the PERC Mentor™ simulator was able to differentiate between competent and non-competent PGTs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

ACGME:

Accreditation Council for Graduate Medical Education

BLUS:

Basic Laparoscopic Urologic Surgery

FT:

Fluoroscopy time

MISTELS:

McGill Inanimate System for Training and Evaluation of Laparoscopic Skills

OSCE:

Objective structured clinical examination

PCA:

Percutaneous renal access

PCS:

Pelvi-calyceal system

PCNL:

Percutaneous ephrolithotomy

PCNL-GRS:

Percutaneous Nephrolithotomy—Global Rating Scale

PGT:

Post-graduate trainee

PGY:

Post-graduate year

TURBT:

Transurethral resection of bladder tumor

TURP:

Transurethral resection of the prostate

URS:

Ureteroscopy

References

  1. Frank JR, Snell LS, Cate OT, Holmboe ES, Carraccio C, Swing S (2010) Competency-based medical education: theory to practice. Med Teach 32(8):638–645

    Article  PubMed  Google Scholar 

  2. Simpson JG, Furnace J, Crosby J, Cumming AD, Evans PA, Friedman Ben David M, Harden RM, Lloyd D, McKenzie H, McLaughlan JC et al (2002) The Scottish doctor—learning outcomes for the medical undergraduate in Scotland: a foundation for competent and reflective practitioners. Med Teach 24(2):136–143

    Article  CAS  PubMed  Google Scholar 

  3. Frank JR, Snell LS, Sherbino J (eds) Draft CanMEDS 2015 Physician Competency Framework—Series III. Ottawa, The Royal College of Physicians and Surgeons of Canada; 2014b September. Accessed on 8th March 2015. http://www.royalcollege.ca/portal/page/portal/rc/common/documents/canmeds/framework/canmeds2015_framework_series_III_e.pdf

  4. Frank JR, Danoff D (2007) The CanMEDS initiative: implementing and outcomes-based framework of physician competencies. Med Teach 29(7):642–647

    Article  PubMed  Google Scholar 

  5. Feldman LS, Hagarty SE, Ghitulescu G et al (2004) Relationship between objective assessment of technical skills and subjective in-training evaluations in surgical residents. J Am Coll Surg 198:105–110

    Article  PubMed  Google Scholar 

  6. Fried GM (2008) FLS assessment of competency using simulated laparoscopic tasks. J Gastrointest Surg 12:210–212

    Article  PubMed  Google Scholar 

  7. Sweet RM, Beach R, Sainfort F et al (2012) Introduction and validation of the American Urological Association basic laparoscopic urologic surgery skills curriculum. J Endourol 26:190–196

    Article  PubMed  Google Scholar 

  8. Elkoushy MA, Luz MA, Delisle J et al (2013) Determinants of performance on the transfer task of the basic laparoscopic urologic surgery (BLUS) curriculum administered at objective structured clinical examinations. J Endurol 27(9):1148–1153

    Article  Google Scholar 

  9. Noureldin YA, Elkoushy MA, Andonian S (2015) Assessment of photoselective vaporization of the prostate skills during urology objective structured clinical examinations (OSCE). Can Urol Assoc J 9(1–2):e61–e66

    PubMed  PubMed Central  Google Scholar 

  10. Knudsen BE, Matsumoto ED, Chew BH et al (2006) A randomized, controlled, prospective study validating the acquisition of percutaneous renal collecting system access skills using a computer based hybrid virtual reality surgical simulator: phase I. J Urol 176:2173–2178

    Article  PubMed  Google Scholar 

  11. Matsumoto ED, Hamstra SJ, Radomski SB et al (2001) A novel approach to endourological training: training at the Surgical Skills Center. J Urol 166:1261–1266

    Article  CAS  PubMed  Google Scholar 

  12. George S, Haque MS, Oyebode F (2006) Standard setting: comparison of two methods. BMC Med Educ 6:46

    Article  PubMed  PubMed Central  Google Scholar 

  13. Watterson JD, Soon S, Jana K (2006) Access related complications during percutaneous nephrolithotomy: urology versus radiology at a single academic institution. J Urol 176(1):142–145

    Article  PubMed  Google Scholar 

  14. Ziaee SAM, Sichani MM, Kashi AH et al (2010) Evaluation of the Learning Curve for Percutaneous Nephrolithotomy. Urol J 7:226–231

    PubMed  Google Scholar 

  15. Jang WS, Choi KH, Yang SC et al (2011) The learning curve for flank percutaneous nephrolithotomy for kidney calculi: a single surgeon’s experience Korean. J Urol 52:284–288

    Google Scholar 

  16. de la Rosette J, Assimos D, Desai M, Gutierrez J, Lingeman J, Scarpa R, Tefekli A, CROES PCNL Study Group (2011) The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients. J Endourol 25(1):11–17

    Article  PubMed  Google Scholar 

  17. Noureldin YA, Elkoushy MA, Andonian S (2015) Assessment of percutaneous renal access skills during urology objective structured clinical examinations. Can Urol Assoc J 9(3–4):104–108

    Article  Google Scholar 

  18. Gurusamy KS, Aggarwal R, Palanivelu L et al (2009) Virtual reality training for surgical trainees in laparoscopic surgery. Cochrane Database Syst Rev 1:CD006575

    PubMed  Google Scholar 

Download references

Acknowledgments

This work was partially sponsored by Fonds de la Recherche Santé du Québec (FRSQ) Chercheur Boursier grant to Dr Sero Andonian and by a grant from the Urology Care Foundation Research Scholars Program and the Boston Scientific Corporation, the Endourological Society, and the “Friends of Joe” to Dr. Yasser Noureldin, and the CUASF-SIU International Scholarship grant to Dr. Yasser Noureldin. The PERC Mentor™ simulator was purchased with funds from the RVH and MGH foundations.

Authors’ contribution

YA Noureldin: Conception and design, data acquisition, data analysis and interpretation, drafting the manuscript and critical revision of the manuscript for scientific and factual content. N Fahmy: Data acquisition and critical revision of the manuscript for scientific and factual content. M Anidjar: Data acquisition and critical revision of the manuscript for scientific and factual content. S Andonian: Conception and design, data acquisition, data analysis and interpretation, drafting the manuscript and critical revision of the manuscript for scientific and factual content.

Author information

Authors and Affiliations

  1. Division of Urology, McGill University Health Center, McGill University, 1001 Boul Decarie, Suite D05.5331, Montreal, QC, H4A 3J1, Canada

    Yasser A. Noureldin, Nader Fahmy, Maurice Anidjar & Sero Andonian

  2. Department of Urology, Benha University Hospital, Benha University, Benha, Egypt

    Yasser A. Noureldin

Authors
  1. Yasser A. Noureldin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nader Fahmy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maurice Anidjar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sero Andonian
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sero Andonian.

Ethics declarations

Conflict of interest

Authors declare no conflict of interest and no financial relationship with Symbionix.

Ethical statement

This study was conducted in concordance with the Declaration of Helsinki 2013 and after obtaining McGill University ethics approval (No. A03-E24-14B) and informed consents.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Noureldin, Y.A., Fahmy, N., Anidjar, M. et al. Is there a place for virtual reality simulators in assessment of competency in percutaneous renal access?. World J Urol 34, 733–739 (2016). https://doi.org/10.1007/s00345-015-1652-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-015-1652-y

Keywords

Search

Navigation