Stakeholder perspectives and status of surgical simulation and skills training in urology residency programs in Canada

Abstract

Introduction: With the shift to competency-based training, surgical skills lab training (SSLT) may become a mandatory part of Canadian urology residency programs (CURPs). This study aims to identify: 1) the status of SSLT in CURP; 2) stakeholder perspectives on the utility of SSLT; 3) barriers to developing and implementing SSLT; and 4) how to address these barriers.
 Methods: Surveys were developed and issued to three groups of stakeholders: 1) SSLT directors at all 13 CURPs (response rate 100%); 2) teaching faculty (response rate 33%); and 3) urology residents (response rate 24%). Surveys 2 and 3 were sent to ten English CURP. Results were collected through email and SurveyMonkey®.
 Results: Nine of 13 CURPs have a dedicated SSLT; 46% of CURP have 1–3 sessions per year, 8% have 5–7, and 30% >7. Most residents have independent lab access, but 80% do so less than once monthly. Over 90% of stakeholders find SSLT useful, of which high-fidelity models are most preferred (faculty rated 3.66/4, residents 3.18/4). Program directors (PDs) identified lack of protected faculty time, funding, and infrastructure as the top three barriers to SSLT implementation. Residents found lack of faculty time, protected academic time, and infrastructure as barriers. PDs viewed protecting faculty time and more funding as potential solutions, while residents suggested protected faculty and academic time, and after-hours lab access.
 Conclusions: Residents, faculty, and PDs in CURPs view SSLT as useful. Most CURPs have defined SSLT; programs without this have labs for resident use but are underused. To continue to develop and progress SSLT, more time, participation, and funding must be made available.

Hemorrhaging laparoscopic partial nephrectomy — feasibility of a novel simulation model

“…As such, the evidence to support incorporating laparoscopic skills training into urology programs has long been acquired [16][17][18][19] with the majority of Canadian urology programs offering laparoscopic simulation training. 10 In realworld clinical practice however, laparoscopic surgery takes place in an operating room with multidisciplinary teams. The operating room consists of a dynamic multidisciplinary team environment where technical skills intersect with non-technical skills such as communication, leadership, situation awareness and shared decision-making.…”

“…21 While SBTT remains a key mechanism by which to train and teach both technical skills and non-technical skills [22][23][24][25] , literature review has shown that few urology programs have incorporated the deliberate practice of non-technical skills, either within their programs or as multidisciplinary teams. 10,26,27 A dynamic simulation scenario, like the one described, provides a fertile environment for urology residents to practice their non-technical surgical skills both at a junior and senior level of training. Surveys have highlighted that urology programs support simulation training, particularly for technical skill teaching of junior residents 10 however non-technical skill training is beneficial and should be practiced at all levels of training including junior and senior resident training level.…”

“…The responses regarding simulation experiences from our cohort mirror that of recently published literature. 10,26 The urology residents from this pilot study responded that they have had limited multidisciplinary simulation exposure, ranging from zero to five simulations. Of those simulations, the majority took place during their junior surgical training years in simulated emergency department scenarios or non-operating room scenarios.…”

“…4,5 Despite the availability of such described models, a recent Canadian survey of academic urology program stakeholders including program directors, academic staff, and residents, found programs have limited simulation experiences within their protected academic teaching time, even though most stakeholders agreed on the value of simulation to be utilized as a teaching method in urology. 10 Based on the previously described simulation models and scenarios in urology 6,9,11 , we aimed to develop a renal model to challenge the non-technical skills of urology residents. A key feature of practicing non-technical skills in an operative crisis is to encourage residents, who may progress easily through a technical skill, to still challenge and practice their non-technical skills.…”

A continued need for simulation facilities, technologies, and resources in Canadian urology training

“…More inexperienced learners, such as junior residents, can have very effective simulated learning on low-fidelity and material models, which is probably reflected in their positive assessment of their simulation experience in the survey-based study by Lobo et al in this issue CUAJ. 3 Senior residents really need the higher fidelity platforms to improve their more advanced and specific surgical skills learning needs. However, the observation that residents are not using the skills training labs because the practice is not mandatory and they are too busy reflects the importance of making simulation-based practice an integral portion of the curriculum.…”