Elsevier

Urology

Volume 110, December 2017, Pages 45-50
Urology

Endourology and Stones
Validation of the Advanced Scope Trainer for Flexible Ureterorenoscopy Training

https://doi.org/10.1016/j.urology.2017.07.047Get rights and content

Objective

To validate the Advanced Scope Trainer (AST; Mediskills, Northampton, UK). The AST is a currently unvalidated simulator, developed for flexible ureterorenoscopy (fURS) training. This study aims to assess the face, content, construct, and concurrent validity to assess the level of transferability of skills to the operating room.

Materials and Methods

This prospective, observational, and comparative study recruited novices (n = 19) and trainees (n = 34), with participants performing a diagnostic fURS, followed by removal of a lower pole stone, on the AST. Fifteen participants performed a fURS on fresh frozen cadavers to assess concurrent validity. Trainees were supervised by expert urologists (n = 7) during each procedure. Performance was evaluated using the validated Objective Structured Assessment of Technical Skills (OSATS) assessment. Face and content validity were demonstrated by anonymous surveys from participants and faculty.

Results

Face validity assessment revealed that trainees found the simulator was 76% realistic (3.8/5 on a Likert scale). Laser stone fragmentation (4.11 ± 0.85) and manual stone extraction (4.03 ± 0.85) were thought to be the most realistic components and guidewire insertion (3.14 ± 1.35) the least. Participants also believed the simulator to be useful, giving transferrable skills to take into the operating room, demonstrating content validity. Using an OSATS assessment, concurrent validity was demonstrated in “respect for tissue” (P = .0105) and “time and motion” (P = .0196). Construct validity was also demonstrated when comparing novices to trainees (mean OSATS 10.11 ± 2.28 vs 23.89 ± 5.38).

Conclusion

This study has demonstrated face, content, construct, and concurrent validity of the AST for fURS training. Further evaluation is necessary to demonstrate construct and predictive validity of skills gained using the model.

Section snippets

Study Design and Participants

This prospective, observational, and comparative study recruited 60 participants, comprising 19 medical students, 34 urologic trainees, who have performed less than 10 procedures, and 7 senior urologists of consultant/specialist level from whom different training sessions were derived (UK, Austria, Japan, and China).

The Advanced Scope Trainer

This model is constructed from high tensile elastomeric silicone and comprises a distensible bladder, realistic ureteric orifices, 2 ureters and 2 kidneys with renal pelvises and

Demographics

The participants consisted of 19 novices (medical students), 34 junior urologic residents, and 7 senior specialists. The junior residents were mostly (n = 14) in their third year of urology-specific postgraduate training, with 24% being in their first year of specialty training. They ranged in age between 24 and 50 years old (mean = 31.2).

Face and Content Validity

On a Likert scale (1 = “least useful”, 5 = “most useful”), most trainees believed the model was overall 76% realistic (3.8/5). Laser stone fragmentation

Discussion

Over the past few decades, the field of surgical simulation and the quality of simulation models have expanded and improved to the point where it is becoming standard in surgical education and training. There is a great variety of procedural simulators or models available for urologic procedures, including for ureterorenoscopy,5 transurethral resection and related laser procedures,6, 11, 12, 13 laparoscopy,6, 14 and robotic surgery.15, 16

The current study employed a robust training and

Conclusion

This study has demonstrated face, content, construct, and concurrent validity of the AST for fURS training despite reported limitations in ureteral orifice catheterization. Further evaluation is necessary to compare its effectiveness against other available models and demonstrate the predictive validity of skills gained using the model.

Acknowledgment

The authors thank Boston Scientific for providing the laser machine during sessions, Olympus for providing all other necessary instruments, and Mediskills for providing an academic discount when purchasing the models. The authors would like to thank Dr. Faizan Dar for his contributions to the study.

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    Financial Disclosure: The authors declare that they have no relevant financial interests.

    Funding Support: Abdullatif Aydin, Kamran Ahmed, and Prokar Dasgupta acknowledge support from The Urology Foundation and Olympus. Prokar Dasgupta and Kamran Ahmed acknowledge support from the NIHR Biomedical Research Centre, MRC Centre for Transplantation, King's Health Partners, Guy's and St. Thomas' Charity, School of Surgery, London Deanery, Royal College of Surgeons of England, Intuitive Surgical, EU-FP7, Prostate Cancer UK, Technology Strategy Board, and The Vattikuti Foundation.

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