Urological Skills Research Articles

Implementation of a Urologic Surgery Skills Fair for Medical Students

To increase the proportion of applicants to urology residencies, we created a surgical skills fair to introduced urology early in undergraduate medical education. Funded by the Department of Urology, the fair was designed to have student rotations through 12 hands-on practice stations supervised by faculty and an advanced care practitioner or resident physicians. At conclusion, medical students completed a voluntary survey about their experience. Surgical skills fairs were organized at Yale School of Medicine (New Haven, CT) in 2022 and 2023. The fair was designed to encourage interaction between medical students, urology residents, and urology faculty by highlighting common urologic procedures and skills. The fair was well received by medical students at all levels of training. Over 2 years, 155 medical students attended, including 67 (43%) first-year and 60 (39%) second-year medical students. Eighty-two medical students completed the survey. An average of 19 attendings, advanced care practitioners and residents attended each event. Of the survey respondents, 42.7% reported prior interest in a surgical specialty but had not considered urology. Students reported increased interest in urology and greater confidence in urologic skills after the event (p < 0.001). We demonstrate that creating a surgical fair in urology is feasible and enhances early exposure and interest in urology. For students who do not pursue urology, the fair provides knowledge of urological pathologies and valuable skills for all physicians.

A needs assessment for simulation-based training in emergency urological skills in Ethiopia.

Urologic emergencies are common and complications from their management are high. Simulation-based education (SBE) is a highly effective training method, allowing trainees to learn both technical and nontechnical skills in a safe environment. Training in the management of urological emergencies is limited in many healthcare settings, so we performed a needs assessment for a urological emergencies SBE course in Ethiopia. This study presents data from a descriptive cross-sectional, survey-based survey of consultants and residents in the Ethiopian surgical community. The survey was disseminated using online Google Forms, through social media (WhatsApp), and to colleagues in the College of Surgeons of East, Central and Southern Africa (COSECSA) via email and social media. One hundred-seven results were received; two were discarded due to incomplete data. Fifty three of the respondents were general surgeons and 38 of the respondents were urologists. Sixty nine respondents strongly agreed that simulation-based training was important for first-year surgical residents, whereas twenty-five respondents agreed and nine respondents strongly disagreed; one respondent disagreed and one was neutral. Eighty seven respondents suggested a 3-day training course, whereas 17 respondents suggested a two-day course. More than 80 of the respondents rated training in the management of acute urinary retention, acute scrotum, urethral, and suprapubic catheterization as extreme or very important and 79 respondents wanted education about urologic trauma and Fournier's gangrene. Surgical and urology residents in Ethiopia have expressed a need for, and a strong interest in, simulation-based urological emergency training.

"Self-Designed Simulation-Based Laparoscopic Training Program for Urology Residents: Results After 6 Years of Experience".

Learning laparoscopy (LAP) is challenging and requires different skills to conventional open surgery. There is a recognized need for a standardized laparoscopic training framework within urology to overcome these difficulties and to shift learning curve from patient to skills laboratory. Simulation-based training has been widely commented, but implementation in real day practice is lacking. We present our "LAP training program for residents". Between 2017 and 2022, 11 residents participated in our self-designed program: Theoretical: (Moodle platform) basic knowledge and multimedia content for initiation into LAP. Evaluated through online exam. Practical: exercises for LAP skills acquisition were proposed and encouraged residents' practice in a box trainer available and experimental surgery sessions on a porcine model. On-site E-BLUS (European Basic Laparoscopic Urologic Skills) examination was performed annually. Feedback was obtained through an anonymous online survey. All residents positively evaluated the program. Theoretical: 82% passed the online exam. The most valued topics: LAP in special clinical situations, complications, instruments, and configuration of the operating room (OR). Practical: all residents increased dry-lab box practices. A total of 23 experimental surgical sessions were carried out. For 64%, simulation in the experimental OR was a necessary complement to achieve laparoscopic skills and allowed them to feel more confident. Forty-five percent considered it essential to improve their surgical technique. E-BLUS evaluation was valued as a means to achieve dexterity and safer surgery by 90%. Reduction in time and errors were observed through time, although only 2 passed the E-BLUS. Our program for learning LAP includes the acquisition of knowledge, training of basic skills and surgical technique in a safe environment, as well as an objective evaluation. Encouraged practice of basic skills and surgical technique simulation and improved objective evaluation. It is structured, reproducible, systematic and has been positively valued, although it requires commitment for success.

Comparative evaluation of simulators for practising fluoroscopy-guided renal pelvic puncture

Introduction. The skill of puncture of the kidney pelvicalyceal system is one of the basic urological skills, as it is used for various surgical interventions. There are different training models, from laboratory animals to virtual reality simulators.Objective. To evaluate a non-biological model of the pelvicalyceal system puncture simulator UroATOM (“Alfa-Rhythm”, Russian Federation) and to compare it with a virtual reality simulator PERC MentorTM (“Simbionix”, Beit Golan, Israel).Materials &amp; methods. The results of fluoroscopic guided puncture training were analyzed among 50 physicians. The specialists were divided into two equal groups by experience: group 1 — beginners, group 2 — experienced urologists. In phase 1, both simulators were evaluated by the physicians using Likert questionnaires. In phase 2, the puncture results in beginners were evaluated before and after the UroATOM simulator practise.Results. Comparing the indices of both simulators showed that UroATOM was rated as more convenient to use (p = 0.0001) and cheaper (p &lt; 0.0001). The analysis of the puncture performance by "beginners" before and after UroATOM training revealed a statistically significant improvement in the performance. The puncture time index improved by 79 seconds. The index of fluoroscopy duration decreased by 40.9 seconds. The number of puncture attempts decreased by 1.4 times. The amount of contrast decreased by 5.4 ml.Conclusions. The UroATOM simulator is effective for training young specialists in fluoroscopy-guided renal cavity puncture.

Prospective, Randomized Comparative Evaluation of a Novel Hands-On Endourology Training Curriculum

Introduction: The aim of this randomised prospective trial was to evaluate a novel hands-on endourological training programme (HTP) and compare it to the standard endourological colloquium (SC). Methods: A new HTP was created based on a sequence of theoretical, video-based, and practical elements emphasising contemporary teaching methods. An existing SC in which live endourological operations were attended served as a comparison. Medical students were enrolled in a ratio of 1:2 (SC:HTP). Objective knowledge questionnaires (5 questions, open answers) and subjective Likert-type questionnaires (rating 1–3 vs. 4–5) were used for evaluation. Primary endpoint was urological knowledge transfer; secondary endpoints were learning effects, progression, and urological interest. Results: 167 students (SC n = 52, HTP n = 115) were included. The knowledge assessment showed a significant increase in knowledge transfer benefitting the HTP on all 5 surveyed items (mean: n = 4/5/4/3/2 vs. n = 2/3/1/1, p < 0.0001). Interest and duration of the course were rated significantly more positively by HTP students (100.0/95.0% vs. 85.0/70.0%, p < 0.0001). The HTP students were significantly more confident in performing a cystoscopy independently (HTP 43.5% vs. SC 11.5%, p < 0.0001) and significantly claimed more often to have gained interdisciplinary and urological skills during the course (HTP 90.0/96.5% vs. SC 23.1/82.7%, p < 0.0001/p = 0.003). HTP students were also more likely to take the course again (HTP 98.2% vs. SC 59.6%, p < 0.0001). Conclusion: Modifying endourological teaching towards hands-on teaching resulted in stronger course interest, greater confidence regarding endourologic procedures, and significantly increased urologic knowledge transfer.

EDITORIAL COMMENT

In this article, “Urology Boot Camp: A Pilot Medical Student Curriculum For Common Bedside Urologic Procedures,” the authors developed a novel, urology-specific (catheter placement and irrigation) "boot camp" for third year medical students. The boot camp was very thoughtfully designed to minimize in-person instruction time, and included an online module that students needed to view ahead of time, followed by a single hands-on session. The intervention was incredibly well-received by students, who said they would recommend repeating it for others and reported increased comfort with Foley catheter placement and irrigation. As urologists we have a vested interest in exposing medical students to the most basic and fundamental urologic procedures for multiple reasons; not only can this early exposure pique interest in our fantastic field, but knowledge of basic bladder management can be utilized in every field of medicine. The intervention reported on in this article is simple and reproducible. The logical next step is how it can be scaled to reach more students. There are 192 medical schools in the US (MD and DO), and rather than every institution re-inventing the wheel to develop their own curriculum, this is an opportunity ripe for standardization and facilitation of such skill and educational sessions. The American Urological Association has been, and should continue to be, a driver in these efforts to standardize educational sessions and afford their broad availability. Simulation allows for exposure and repetition of skills in a low-stress and low-risk environment. If cost prohibits model-based simulation of the skills discussed in this article, consideration can be given to low-fidelity simulation of the same skills, as a rudimentary lower urinary tract can certainly be simulated without a costly human model. We applaud the authors for addressing an unmet need in medical education and are encouraged by the interest in empowering the next generation of physicians to gain confidence and competence in basic urologic skills.

618 A Registrar - Delivered Urology Experience Improves Medical Student Knowledge of the Subject and Increases Interest in a Surgical Career

Abstract Introduction Exposure to Urology is thought to vary considerably between medical schools, leading to a lack of competence by foundation doctors in basic urological skills and knowledge, and perhaps low interest in a urological / surgical career. In our hospital students had no dedicated Urology placement until 2020. Method A weeklong Urology placement was designed for 3rd year students. This comprised tutorials on topics set out by the university curriculum, a catheter insertion simulation session, and regular theatre and ward rounds. Most students also had the opportunity to insert a catheter on the ward / theatre. Students were encouraged to complete The National Catheter Education Programme, an online course providing a point for CST applications. This placement is registrar delivered, giving a more accurate idea of what a surgical career involves. Student feedback was obtained on the first and last days to ascertain self-rated confidence on a Likert-type scale regarding urological key topics, as well as career intentions. Results Self – rated knowledge on the 5 identified topics at the start of the week was most likely to be “Poor,” and by the end “Good” or “Very good.” By the end of the week most students indicated they were much more likely to pursue a career in surgery, although the same response was not seen as strongly for the subspeciality of Urology. Conclusions The placement continues to run and develop based on feedback. We look forward with interest to the publication of LEARN (uroLogical tEAching in bRitish medical schools Nationally) — a multicentre audit – to further inform this project.

Persistent cloaca in the gynecologist's practice (a literature review)

Introduction. Cloacal abnormalities are rare congenital malformations having the most severe and complex forms of anorectal and urogenital malformations. Patients - always females who are born with the persistent cloaca - at the stage of embryogenesis had a merging of lower urethra, vagina and rectum into a single canal or cavity which is opened posterior to the clitoris. The persistent cloaca remains a challenging reconstructive problem for pediatric gynecologists, urologists and surgeons. Doctors must have skills in surgical urology, proctology and in all types of plastic surgery on the vagina and cervix.Material and methods. Data searches were conducted in PubMed and Google Scholar. The following keywords were used: “Cloacal abnormalities” and “Persistent cloaca”.Conclusion. Regardless of a technique, goals for cloaca management remain the same. The primary surgical procedure is aimed to restore normal anatomical positioning of pelvic organs and to form the urethra, vagina and rectum as well as to achieve control over bowel function, urination and reproductive potential of the patient. A surgical correction of persistent cloaca should be performed in specialized medical institutions by specialists having experience in treating children with anorectal anomalies.

Teaching Urology to Undergraduates: A Prospective Survey of What General Practitioners Need to Know.

Background: Higher education training in Medicine has considerably evolved in recent years. One of its main goals has been to ensure the training of students as future adequately qualified general practitioners (GPs). Tools need to be developed to evaluate and improve the teaching of Urology at the undergraduate level. Our objective is to identify the knowledge and skills needed in Urology for the real clinical practice of GPs. Methods: An anonymous self-administered survey was carried out among GPs of Primary Care and Emergencies which sought to evaluate urological knowledge and necessary urological skills. The results of the survey were exported and descriptive statistics were performed using IBM SPSS Statistics version 19.0. Results and limitations: A total of 127 answers were obtained, in which ‘Urological infections’, ‘Renal colic’, ‘PSA levels and screening for prostate cancer’, ‘Benign prostatic hyperplasia’, ‘Hematuria’, ‘Scrotal pain’, ‘Prostate cancer diagnosis’, ‘Bladder cancer diagnosis’, ‘Urinary incontinence’, and ‘Erectile dysfunction’ were rated as Very high or High formative requirements (>75%). Regarding urological skills, ‘Abdominal examination’, ‘Interpretation of urinalysis’, ‘Digital rectal examination’, ‘Genital examination’, and ‘Transurethral catheterization’ were assessed as needing Very high or High training in more than 80% of the surveys. The relevance of urological pathology in clinical practice was viewed as Very high or High in more than 80% of the responses. Conclusions: This study has shown helpful results to establish a differentiated prioritization of urological knowledge and skills in Primary Care and Emergencies. Efforts should be aimed at optimizing the teaching in Urology within the Degree of Medicine which consistently ensures patients’ proper care by future GPs.

MP12-17 EVALUATION UROLOGICAL TEACHING IN BRITISH MEDICAL SCHOOL NATIONALLY: THE LEARN MULTICENTRE CROSS-SECTIONAL STUDY

You have accessJournal of UrologyEducation Research II (MP12)1 Sep 2021MP12-17 EVALUATION UROLOGICAL TEACHING IN BRITISH MEDICAL SCHOOL NATIONALLY: THE LEARN MULTICENTRE CROSS-SECTIONAL STUDY Vinson Wai-Shun Chan, Alexander Ng, Aqua Asif, Chon Meng Lam, Alexander Light, Keerthanaa Jayaraajan, William A. Cambridge, Melissa G. Matthews, Keiran D. Clement, Meghana Kulkarni, Nikita R. Bhatt, Sinan Khadhouri, and Veeru Kasivisvanathan Vinson Wai-Shun ChanVinson Wai-Shun Chan More articles by this author , Alexander NgAlexander Ng More articles by this author , Aqua AsifAqua Asif More articles by this author , Chon Meng LamChon Meng Lam More articles by this author , Alexander LightAlexander Light More articles by this author , Keerthanaa JayaraajanKeerthanaa Jayaraajan More articles by this author , William A. CambridgeWilliam A. Cambridge More articles by this author , Melissa G. MatthewsMelissa G. Matthews More articles by this author , Keiran D. ClementKeiran D. Clement More articles by this author , Meghana KulkarniMeghana Kulkarni More articles by this author , Nikita R. BhattNikita R. Bhatt More articles by this author , Sinan KhadhouriSinan Khadhouri More articles by this author , and Veeru KasivisvanathanVeeru Kasivisvanathan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001985.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The percentage of medical schools mandating urology rotations in the USA has decreased from 99% in 1956 to 17% in 2009, whereas 65% of medical school directors stated in 2008 that it was possible for their students to have graduated without a clinical rotation in urology. METHODS: LEARN is a national cross-sectional study. Year 2-5 medical students and postgraduate-year 1 doctors (PGY1) from all medical schools in the UK were invited to complete a survey between the 3rd October 2020 and 20th December 2020. The objectives of this study are to evaluate the quantity and types of urology teaching of all UK medical schools against the British Association of Urological Surgeons undergraduate syllabus and the mandated urological skills requirements set out by the UK General Medical Council. Students’ and PGY1s’ perceptions of urology as a career were also evaluated. RESULTS: 7,594 (91%) eligible responses out of the 8,346 responses from all 39 eligible medical schools were analysed. Amongst 1,253 PGY1s, 21% (259/1253) have graduated without any clinical attachment in Urology. Andrology teaching is severely underrepresented. 13.1% (164/1253) have never performed a male genital examination on either a model or a patient. 44% (554/1253), 52% (657/1253) and 59% (745/1253) of interns have never had any teaching on erectile dysfunction, male infertility or male urinary incontinence, respectively. In contrast, general urology such as urinary tract infections, acute kidney injury, and haematuria are well-represented in the curriculum (Table). Only 53% (658/1253) and 17% (212/1253) of PGY1s believed they had sufficient urology teaching in their medical course and have considered a career in urology, respectively. CONCLUSIONS: LEARN is the largest evaluation of the undergraduate urology curriculum to date worldwide. While most urology topics were found to be well-represented in the curriculum, LEARN has identified weaknesses in the curriculum, such as clinical exposure and andrology. The LEARN study will provide crucial evidence in reforming the urology curriculum to ensure competent and adequate urology knowledge in training doctors regardless of their future career choice. Source of Funding: Nil © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e195-e195 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vinson Wai-Shun Chan More articles by this author Alexander Ng More articles by this author Aqua Asif More articles by this author Chon Meng Lam More articles by this author Alexander Light More articles by this author Keerthanaa Jayaraajan More articles by this author William A. Cambridge More articles by this author Melissa G. Matthews More articles by this author Keiran D. Clement More articles by this author Meghana Kulkarni More articles by this author Nikita R. Bhatt More articles by this author Sinan Khadhouri More articles by this author Veeru Kasivisvanathan More articles by this author Expand All Advertisement Loading ...

Abstract 50 - The inclusion of practical urology skills in intern induction: A pilot programme in the Dublin Mid Leinster Network

Abstract 50 - The inclusion of practical urology skills in intern induction: A pilot programme in the Dublin Mid Leinster Network

An emergency urology skills course for the multidisciplinary team

Urological presentations account for approximately 1.7% of emergency hospital admissions, 7.8–20% of the acute surgical take and 5–10% of visits to general practice. Training in this area is often unsatisfactory, with a third of final year medical students not feeling confident in managing urological emergencies and 6% receiving no exposure at all. Urology is a multidisciplinary speciality, and many emergency urological presentations require urgent treatment with specialised equipment or skills. A quality improvement project was set up at Gloucestershire Hospitals NHS Foundation Trust with the aim of improving experience and confidence among junior doctors and allied health-care professionals with common urological practical skills using a simulation-based course. There was an emphasis on multidisciplinary team working to mirror the clinical environment. Pre-course questionnaires showed that most participants lacked confidence with common urology practical skills, such as haematuria management (80–85%), nephrostomy management (93–95%) and suprapubic catheters (93–100%). After attending the course, confidence improved in all skills, and participant satisfaction was high, with 100% finding the course relevant to clinical practice. The course was run at low cost, free to participants and without the need for long periods of study leave, making it accessible to all. We suggest the model of this course could be easily transferred to other hospital trusts and applied to other surgical specialities for similar simulated training. Level of evidence: Level 5.

Simulator based teaching of Trans-Urethral Resection of Prostate (TURP) skills in urology.

Background: After the introduction of simulators in urology, urology education has evolved significantly. The development of Transurethral Resection of Prostate (TURP) skills has shifted to simulator-based learning from being directly on patients. We evaluated the outcome of simulation-based teaching of TURP procedural skills on virtual reality simulator and objectively assessed the operative skills on the Global Rating Scale (GRS).&#x0D; Methodology: In this prospective comparative study, high fidelity (VirtaMed | UroSim™) simulator was used. A total of 17 participants were enrolled in this study, 4 were urology faculty members, and 13 were post-graduate urology trainees. All participants performed five attempts of real-time TURP complete procedure and were allowed to resect the maximum possible prostate tissue (goal ≥ 85%). Skills were assessed in terms of resection, bleeding control and safety parameters. Objective assessment of simulative operative skills was done on GRS score sheets by faculty, based on the Global Rating Index for Technical Skills (GRITS) and OSATS. The data from the 1st and 5th attempts of all participants was analyzed on SPSS version 22.0.&#x0D; Results: There was statistically significant difference in the mean resection score at 1st attempt between faculty and trainees i.e. 112±8.6 and 86.69±9.95, respectively (p&lt;0.01), while the scores were comparative by the 5th attempt. All the enrolled members resected &gt;80% of prostate volume (40 score points). Similarly, for the parameters associated with bleeding control, there was a significant difference in the bleeding control, lost blood and remaining bleeders between trainees and faculty members (p&lt;0.01) at 1st attempt while on 5th attempt, the outcomes were comparative in both groups. The objective assessment of operative skills of the trainee’s displayed improvement in all 5 parameters including tissue injury, movement and time, instrument application, surgical process and surgical details.&#x0D; Conclusion: Simulation-based TURP teaching significantly improves simulative operative skills in resection, bleeding control and safety parameters. GRS is an effective tool in assessing simulative operative skills and may evaluate endo-urological procedural training in urology trainees periodically.

How the use of the artificial intelligence could improve surgical skills in urology: state of the art and future perspectives.

As technology advances, surgical training has evolved in parallel over the previous decade. Training is commonly seen as a way to prepare surgeons for their day-to-day work; however, more importantly, it allows for certification of skills to ensure maximum patient safety. This article reviews advances in the use of machine learning and artificial intelligence for improvements of surgical skills in urology. Six studies have been published, which met the inclusion criteria. All articles assessed the application of artificial intelligence in improving surgical training. Different approaches were taken, such as using machine learning to identify and classify suturing gestures, creating automated objective evaluation reports, and determining surgical technical skill levels to predict clinical outcomes. The articles illustrated the continuously growing role of artificial intelligence to address the difficulties currently present in evaluating urological surgical skills. Artificial intelligence allows us to efficiently analyze the surmounting data related to surgical training and use it to come to conclusions that normally would require human intelligence. Although these metrics have been shown to predict surgeon expertise and surgical outcomes, evidence is still scarce regarding their ability to directly improve patient outcomes. Considering this, current active research is growing on the topic of deep learning-based computer vision to provide automated metrics needed for real-time surgeon feedback.

O52: THE IMPACT OF STUDENT BACKGROUND ON PERFORMANCE AND STRESS DURING SURGICAL SIMULATION

Abstract Introduction Early exposure of medical students to surgical skills has been associated with an increased interest in pursuing a career in surgery. This study aimed to investigate the impact of student background on basic laparoscopic skills acquisition and perceived stress to workload during simulation. Method Students were recruited to a course modelled on the European Basic Laparoscopic Urological Skills (E-BLUS) programme. Students filled out a pre-course demographic survey, and a post-course survey that evaluated perceived stress to workload (SURG-TLX). Pre- and post-course confidence in laparoscopic skills, performance in the course, as well as SURG-TLX parameters were statistically compared for all demographic factors. Result Twenty-three participants completed the course, fifteen (65%) of which were female. Ten students were junior (first and second year), and thirteen were senior (third year and above). Hobbies were grouped into either requiring hand-eye coordination (n=9), manual dexterity (n=9), or no relevance to surgery (n=5). No significant differences were found in demographic factors for course performance or pre- and post-course confidence. No significant differences were found between male and female students, and between different hobby groups, in all SURG-TLX parameters. Senior students reported a significantly higher Physical Demand of the SURG-TLX compared to juniors (p=0.042). No differences were found in other parameters. Conclusion Our study showed no correlation between student background (notably sex and stage of medical school) and basic laparoscopic skills acquisition or stress during simulation. We therefore suggest that medical students are provided with more exposure to acquire basic laparoscopic skills regardless of their background. Take-home message Medical student background is not a discriminator in surgical simulation performance and stress. All medical students, regardless of their sex or stage of medical school, should be given the opportunity to practice laparoscopic skills.

Can narration and guidance in video-enhanced learning improve performance on E-BLUS exercises?

IntroductionThis study aimed to compare trainees’ laparoscopic performance concerning the peg-transfer (PT) and needle-guidance (NG) exercises after watching the original European Basic Laparoscopic Urologic Skills (E-BLUS) video or after watching a video-mentored tutorial (VMT) with ‘tips and tricks’, narration and didactic illustrations.Material and methodsAn experimental, unblinded, parallel, 2-intervention, 2-period randomized trial with an allocation ratio of 1:1 was conducted. Forty-two participants were randomized into 2 groups. Prior to task initiation, Group 1 watched the VMT in both trials and Group 2 watched, firstly, the original E-BLUS examination video and, in the second trial, the VMT. Each participant performed 2 trials for each exercise. Outcome measures were task time and total number of errors.ResultsIn the first period, participants who visualized the PT and NG VMT had fewer errors than participants who visualized the E-BLUS video (p = 0.001 and p = 0.014, respectively). In the second period, after watching the VMT, a decrease in the total number of errors in PT and NG exercises was observed in the participants who previously watched the E-BLUS video (p = 0.001 and p = 0.002, respectively). In the second period, a decrease in median task time was observed for Group 1 and 2 after watching the PT VMT (p ≤0.001 and p = 0.003, respectively) and NG VMT (p = 0.005 and p = 0.01, respectively).ConclusionsThe use of VMT can lead to a smaller number of errors and, if coupled with deliberate practice, could lead to a shorter task time in exercise performance among participants with no previous laparoscopic experience.

Urology boot camp for medical students: improving knowledge and confidence in preparation for clinical practice

Objectives: Undergraduate exposure to urology is limited and junior doctors often feel underprepared for managing urological problems. We therefore established a one-day urology teaching course which covered the entire British Association of Urological Surgeons curriculum. Methods: Graduates of a teaching hospital undertook a survey regarding their practical skills and knowledge in urology ( n=20), with responses compared to a sample of students who attended the boot camp ( n=24). Results: Forty per cent of graduates thought they knew most of the curriculum and 0% knew the entire curriculum, increasing to 79.4% and 8.3%, respectively, in the post-boot camp cohort. Forty per cent felt ‘mostly prepared’ for final examinations, increasing to 70.8%; 35% rated their knowledge as ‘good’, increasing to 50%, with a further 12.5% feeling it was ‘excellent’; 0% were ‘very confident’ in examination skills, increasing to 20.8%. One hundred per cent of students thought the boot camp helped in preparation for medical finals, 70.8% felt it better prepared them for foundation training. All course candidates thought the course increased their knowledge and skills in urology. Conclusion: This urology boot camp improves medical students’ skills and knowledge. This course would benefit medical students nationally, providing comprehensive, standardised training in urology and preparing students for final examinations and foundation years. Level of evidence: Not applicable.

Attitude and perception of urology by fifth-year (GEMPIII) students at the end of their mixed block rotation at Wits Medical School

BackgroundThis University Medical School offers a 6-year MBBCh programme, of which the fifth year consists of seven blocks of 6 weeks each of which 2 weeks are mixed rotations in specialities such as ophthalmology, ear–nose–throat and urology. The purpose of the study was to assess the current urology knowledge and skills confidence amongst undergraduate medical students regarding urological diagnostic and therapeutic procedures, in order to evaluate the current curriculum for possible need of improvement.MethodsThis was a qualitative survey of 250 fifth-year medical students from September 2019 to February 2020. The survey was conducted by means of a questionnaire consisting of two parts: The first component covered the students perceptions of the urology rotation, and the second component contained the students self-evaluations. The aim of the study was to evaluate students perceptions of the current urology curriculum and to assess the possible need for improvement in urological knowledge and skill.ResultsOf 250 (100%) voluntary participants, 159 (63.6%) were female and 91(36.4%) were male. The majority of students considered their urology knowledge on lithiasis/stone disease and erectile dysfunction sufficient and were comfortable with male catheterisation. Voiding dysfunction, paediatric urology and uro-oncology were the subjects students commonly expressed a deficit in. There was a statistical significant difference in females having a more positive attitude to urology, than males (p = 0.02). No statistical significant difference in attitude to urology was found between students who rotated in one center opposed to students who rotated in another center. Indeed, the majority of students had a negative attitude to urology at the end of the mixed block rotations regardless of the training location. Unattractivity and lack of knowledge were the most common reasons for not choosing urology as a career.ConclusionThe study reveals a need for improvement in basic urological knowledge and skills during the mixed block rotation. A more practical curriculum, taking into account: bedside teachings, attendance of urological clinics and more exposure to urological patients, are some suggestions to be considered in improving the urological educational curriculum.

Long-Term Effects of Mental Training on Manual and Cognitive Skills in Surgical Education – A Prospective Study

Limited training opportunities and expanding requirements are challenging surgical education, calling for alternative training methods like simulation or mental training. The aim of this study is to evaluate short- and long-term effects of a structured mental training on surgical performance. Medical students without laparoscopic experience were randomly assigned to 3 groups: (1) control (2) video training, and (3) video plus mental training performing 2 E-BLUS (European Training in Basic Laparoscopic Urological Skills) exercises, "peg transfer" (PT) and "cutting a circle" (CC). Group 3 performed a structured mental training course (identification of procedural key steps, relaxation, mental vocalization, and imaging). Longitudinal assessment including binominal checklists, global rating scales (GRS), procedural times, and Test of Performance Strategies (TOPS) were performed at baseline, day 2, 14, and after 16 months. Statistical analysis included ANOVA and general linear models with repeated measures. The study was conducted in "Olympus Training and Education Center Hamburg West" and "Endo Club Academy" at the University Medical Center Hamburg-Eppendorf. Participants were eligible if they were medical students with no experience in laparoscopy. 24 participants were recruited and finished the study. The mental training group maintained significantly better GRS scores at 16 months for PT (mean score 24.6 [95% CI: 21-28.25]) and CC (mean score 22.5 [18.4-26.6]) (both p < 0.01) and performed faster in the latter (261 seconds [Std. Dev 116] vs. 427 seconds [SD 132] vs. 368 seconds [SD 78]) compared to the other groups (p = 0.004). Longitudinally, mental training had a significant effect on TOPS scores and procedural times (p < 0.001 and p = 0.005, respectively). In addition to short time efficacy, our study is the first to ascertain a positive long-term effect of mental training on manual and cognitive skills and might be a useful and cost-effective tool in surgical education.

Evaluation of new motorized articulating laparoscopic instruments by laparoscopic novices using a standardized laparoscopic skills curriculum

BackgroundMotorized articulating laparoscopic instruments (ALI) offer more degrees of freedom than conventional laparoscopic instruments (CLI). However, a difficult learning curve and complex instrument handling are still a problem of ALI. We compared the performance of new prototypes of motorized ALI with CLI in a series of standardized laparoscopic tasks performed by laparoscopic novices. Further, usability of the new ALI was assessed.MethodsA randomized cross-over study with 50 laparoscopic novices who either started with CLI and then changed to ALI (CA) or vice versa (AC) was conducted. All participants performed the European training in basic laparoscopic urological skills (E-BLUS) with each instrument in given order. Time and errors were measured for each exercise. Instrument usability was assessed.ResultsOverall, using CLI was significantly faster (CLI 4:27 min vs. ALI 4:50 min; p-value 0.005) and associated with fewer exercise failures in needle guidance (CLI 0 vs. ALI 12; p-value 0.0005) than ALI. Median amount of errors was similar for both instruments. Instrument sequence did not matter, as CA and AC showed comparable completion times. Regarding the learning effect, participants were significantly faster in the second attempt of exercises than in the first. In the needle guidance task, participants using CLI last demonstrated a significant speed improvement, whereas ALI were significantly slower in the second run. Regarding usability, CLI were preferred over ALI due to lighter weight and easier handling. Nevertheless, participants valued ALI’s additional degrees of freedom.ConclusionUsing new motorized ALI in the E-BLUS examination by laparoscopic novices led to a worse performance compared to CLI. An explanation could be that participants felt overwhelmed by ALI and that ALI have an own distinct learning curve. As participants valued ALI’s additional degrees of freedom, however, a future application of ALI could be for training purposes, ideally in combination with CLI.