Current Landscape of Surgical Assessment Models in Urology Residency Training

Abstract

Purpose:Assessing trainees’ surgical proficiency is an important aspect of urological surgical training. The current standard is the Urology Milestone Project, initially implemented in 2013. This evaluation is limited in that it contains only 3 questions on surgical competency per surgical modality with assessments occurring semi-annually without real-time operative feedback. However, since the Urology Milestones Project’s inception a plethora of competency-based surgical assessment tools have been described. We aim to perform a comprehensive review of the literature of these available tools and analyze their strengths and weaknesses as a way of providing a repository of available assessment strategies for further development of a more comprehensive and standardized assessment tool.Materials and Methods:A review of the primary literature was performed using key words such as “surgical assessment tools urology,” “surgical assessment tools prostate,” “bladder surgical assessment tools,” “renal surgical assessment tools urology,” and “surgical assessment tools urology task specific.” Technical and nontechnical skill assessments were included. One reviewer identified and analyzed studies that published assessment tools for use in surgical and urological training.Results:A total of 1,497 articles published between 1997-2022 were identified. Of these, 34 met the inclusion criteria. Eighteen (52.9%) were specialty nonspecific and 16 (47.1%) were specific for urological training. Of the 18 tools developed for general surgical principles, 12 (66.7%) had some form of validity, 9 (50.0%) were significantly reliable, and 2 (11.1%) were externally validated. Of the 16 tools developed specifically for use in urology training, 13 (81.3%) had some form of validity, 7 (43.8%) were significantly reliable, and none were externally validated. Of these 16 tools, 12 (75.0%) were procedure-specific and 4 (25.0%) were developed for general use in endourological procedures.Conclusions:Surgical training is evolving toward a competency-based model, as evidenced by the increase in assessment tools created within the past 10 years. These instruments not only provide objective feedback to trainees, but also monitor progression. However, they are heterogeneous in construct and utilization. There remains a need for the adoption of a standardized, valid, and reliable tool, ie, both procedure-specific and generalizable across multiple procedures for use in urology training.

Assessing “Spin” in Urology Randomized Controlled Trials With Statistically Nonsignificant Primary Outcomes. Letter.

“…It is a frequently performed but deceptively difficult urological procedure that requires experience and surgical skill to be performed optimally. 2 Our data evaluate patients who were all diagnosed with MIBC on initial resection 3 ; however, we strongly agree with Castaneda et al that if muscle was not present in the initial resection, repeat TURBT should always be performed in the setting of high-grade invasive tumor without muscularis propria to ensure adequate staging and diagnosis. Furthermore, our study adds to the growing body of literature suggesting that repeat TURBT prior to neoadjuvant chemotherapy does not improve survival outcomes 4,5 and potentially could result in inferior outcomes if repeat TURBT resulted in complications that resulted in delay of chemotherapy administration.…”

Current Landscape of Surgical Assessment Models in Urology Residency Training. Reply.

“…Spin and its linguistic relative, the euphemism, are undermining our health care system. 2 With misinformation as rampant as it is, let us do more to protect urological literature. Otherwise, scientific manuscripts will begin to resemble tabloid journalism.…”

Current Landscape of Surgical Assessment Models in Urology Residency Training. Letter.

“…However, we believe that relevant works were erroneously excluded, specifically 3 peerreviewed manuscripts presenting nonspecialtyspecific surgical assessment tools and 2 publications involving urological procedures, ie, robot-assisted radical prostatectomy and robot-assisted partial nephrectomy. [2][3][4][5][6][7] The papers describe performance metrics developed according to the rigorous process codified by the proficiency-based progression (PBP) training methodology. 8 As the first step, a core team of experts characterize the procedure/task, identifying its phases and operationally defined procedure events (ie, steps, errors, and critical errors).…”

“…The metrics presented in the aforementioned studies were primarily developed as tools for training, with the aim of providing explicit, constructive, and formative feedback during deliberate practice teaching. [2][3][4][5][6][7] They are also used to assess the proficiency of trainees performing robotic surgical tasks or robot-assisted radical prostatectomy and robot-assisted partial nephrectomy procedures. Moreover, the tool developed to assess and train robotic suturing and knot tying skills was further validated in a prospective randomized and multicenter study including 48 trainees, which showed that the full PBP training pathway group performed better than the comparison groups.…”

“…As noted in our review, there still remains large variability in the construct and utilization of tools currently developed, and none are widely accepted as a standard. 2 Furthermore, proficiency-based progression has been validated only for robotic surgery, representing the continued need for assessment methods which can be broadly applied across different types of urological procedures.…”