Simulation-based training in urology residency programmes in the USA: Results of a nationwide survey

Abstract

ObjectiveTo evaluate the current usage of simulation in urological education in the USA and the barriers to incorporating a simulation-based educational curriculum, as the shift towards competency-based medical education has necessitated the introduction of simulation for training and assessing both non-technical and technical skills.Materials and methodsResidency programme directors at Accreditation Council for Graduate Medical Education (ACGME)-accredited urology training programmes in the USA were invited to respond to an anonymous electronic survey. The study evaluated the programme directors’ experiences and opinions for the current usage of existing urology simulators. The survey also elicited receptiveness and the barriers for incorporating simulation-based training curricula within urology training programmes.ResultsIn all, 43 completed surveys were received (35% response rate). Amongst responders, 97% (42/43) reported having access to a simulation education centre, and 60% (25/42) have incorporated simulation into their curriculum. A total of 87% (37/43) agreed that there is a role for a standardised simulator training curriculum, and 75% (30/40) agreed that simulators would improve operating room performance. A total of 64% (27/42) agreed that cost was a limiting factor, 12% (5/42) agreed on the cost-effectiveness of simulators, 35% (17/41) agreed there was an increased need for simulator education within work-hour limitations, and 38% (16/42) agreed a simulation programme would reduce patient risks and complications.ConclusionsThe majority of urology programme directors consider that there is a role for incorporating a simulation-based curriculum into urology training. Barriers to implementation include cost burden, need for constant technology updates, need for advanced planning, and willingness of faculty to participate in administration.

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“…At the same time, the importance given to the learning curve needed in different diagnostic and therapeutic procedures to achieve adequate outcomes and results has increased. Many theoretical and practical training models have been introduced with the purpose of reducing the learning curve itself, in order to guarantee significant results in the shortest possible time [4][5][6][7][8]. In particular, in endourology, given the massive use of hands-on technology and instrumentation, we can find models of teaching and training aimed to improve the skills of residents and urologists in the use of these instruments and in the correct execution of procedures [9][10][11][12][13].…”

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“…7 Hence, there is a need to train urologists using simulation-based training to fill in the lacunae of urology training. 8 van Renterghem and Ghazi rightly pointed out that the traditional Halsted principle of "see one, do one, teach one" is no longer feasible given the recent financial, medico-legal and ethical considerations of intraoperative training. 9 Various options in simulation training include animal models (such as pigs), synthetic models, cadaveric laboratories and virtual reality models.…”

“…Barriers to executing simulation-based training include regular updates in technology, cost, need for advance planning to obtain the consumables and difficult to spare time in hectic residency hours in high-volume centers. 8 Lentz et al first documented the positive outcomes of training American residents in PP surgery using cadaveric models as part of the 2017 Society of Urologic Prosthetic Surgeons and Sexual Medicine Society of North America Annual Meeting. The group noted significant improvement in procedural test scores and median surgical confidence levels.…”

“…Hence, there is a need to train urologists using simulation‐based training to fill in the lacunae of urology training 8 …”

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