Introduction With the introduction of novel treatment options for benign prostatic hyperplasia (BPH), decision making regarding surgical management has become ever more complex. Factors such as clinical exposure, equipment availability, patient characteristics and hospital setting may affect what treatment is offered and an informed patient choice. The aim of this study was to investigate how urologists help patients make decisions regarding BPH management and whether their practice would differ if they were the patient themselves. Material and methods A 52-question survey presenting hypothetical clinical scenarios was distributed to European urologists and trainees/residents online and in person. In each scenario, regarding treatment options for BPH, the participant considered themselves firstly as the treating clinician and secondly as the patient themselves. Details regarding the participants' clinical experience, awareness of treatment options and exposure to these options were obtained. Results There were 139 participants; 69.8% of whom were consultants, with 82.1% of participants having practiced urology for more than 5 years. A total of 59.7% of urologists consider themselves BPH specialists. Furthermore, 93.5% of those surveyed had performed transurethral resection of the prostate (TURP), whilst procedures performed the least by participants were minimally invasive surgical therapy (MIST) options. Only 17.3% had seen and 1.4% had performed all of the treatment options. When considering themselves as a patient within standard practice, there was a preference for HoLEP amongst participants. Conclusions The majority of urologists surveyed had minimal experience to newer BPH techniques and MIST, suggesting that more exposure is required. A higher rate of HoLEP was chosen as a treatment option for urologists themselves as a patient than what they would choose as an option for their patients.

Background: Urolithiasis patients often require frequent urinary tract imaging, leading to high radiation exposure. CT Kidney-Ureter-Bladder (CT-KUB) is the gold standard in urolithiasis detection, however it is thought to harbour significant radiation load. Urologists have therefore utilised abdominal radiographs (XR-KUB) as an alternative, though with markedly lower sensitivity and specificity. We present the first contemporary UK study comparing the effective doses of XR-KUBs with low dose CT-KUBs. Method: Fifty-three patients were retrospectively identified in a single centre who underwent both a XR-KUB and a CT-KUB in 2018. Effective-Dose was measured by converting the recorded 'Dose Area/Length Product' via the International Commission on Radiological Protection formula. Results: The average effective dose of XR-KUBs and low dose CT-KUBs were 5.10 mSv and 5.31 mSv respectively. Thirty-four percent (18/53) of patients had a XR-KUBs with a higher effective dose than their low dose CT-KUB. Patients with higher Weight, BMI and AP diameter had higher effective doses for both their XR and low dose CT-KUBs. All patients in our study weighing over 92 kg or with a BMI greater than 32 had a XR-KUBs with a higher effective dose than their low dose CT-KUB. Conclusion: This data supports moving away from XR-KUBs for the investigation of urolithiasis, particularly in patients with a high BMI.

Objective In the last decade non-technical skills (NTS) have emerged as a vital area for improvement within surgery. This study aims to develop and evaluate a Non-technical Skills for Urological Surgeons (NoTSUS) training curriculum and assessment scale. Methods This international, longitudinal and observational study began with a 3-round Delphi methodology to refine curriculum contents and rating scale. Sessions with up to four participants were delivered where each candidate undertook an independent scenario within the validated full immersion simulation environment. Candidates were assessed using both the NoTSS (Non-technical Skills for Surgeons) and NoTSUS rating scales by NTS-trained and non-trained experts. A post-training evaluation survey was distributed. Results 62 participants comprising trainees (n = 43) and specialists (n = 19) undertook the NoTSUS course. The NoTSS and NoTSUS scales correlated well, with a mean difference of 3.3 in the overall total (p = 0.10, r = 0.53). However, there was significant differences in scores between the NoTSS-trained and non-trained raters (n = 28,p = 0.03). A one-way ANOVA test revealed significant improvement throughout the four simulation scenarios in each session (p = 0.02). The NoTSUS curriculum received positive feedback from participants and demonstrated educational value and acceptability. Conclusions The NoTSUS curriculum has demonstrated high educational value for NTS training aimed at urologists, with marked improvement throughout sessions. Correlation of NoTSUS and NoTSS scales proves its suitability for evaluating NTS in future training. Demonstration of inter-rater reliability indicates that the scale is reliable for use in assessment by expert faculty members. Furthermore, qualitative feedback from participants suggests gain of transferrable skills over the course.

You have accessJournal of UrologyImaging/Radiology: Uroradiology I (MP36)1 Apr 2020MP36-14 ARE UROLITHIASIS PATIENTS REALLY EXPOSED TO MORE RADIATION WITH CT KUBS THAN PLAIN ABDOMINAL RADIOGRAPHS? Bob Yang*, Noorunisa Suhail, Johan Marais, Thomas Reeves, Mostafa Ragab, Alister Campbell, Mohammed ElSaghir, Melissa Davies, and James Brewin Bob Yang*Bob Yang* More articles by this author , Noorunisa SuhailNoorunisa Suhail More articles by this author , Johan MaraisJohan Marais More articles by this author , Thomas ReevesThomas Reeves More articles by this author , Mostafa RagabMostafa Ragab More articles by this author , Alister CampbellAlister Campbell More articles by this author , Mohammed ElSaghirMohammed ElSaghir More articles by this author , Melissa DaviesMelissa Davies More articles by this author , and James BrewinJames Brewin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000880.014AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urolithiasis patients often require frequent urinary tract imaging, leading to high radiation exposure. CT Kidney-Ureter-Bladder (CT-KUB) is the gold standard in urolithiasis detection, however is commonly thought to harbour significant radiation load. Urologists have therefore utilised abdominal radiographs (XR-KUB) as an alternative, though with markedly lower sensitivity and specificity. Historical guidelines state the Effective-Dose of XR-KUBs at 0.8mSv, however no contemporary UK data exists comparing this with the current gold standard low dose CT-KUBs. We compared the radiation Effective-Dose (mSv) of XR-KUBs and low dose CT-KUBs. METHODS: 53 patients were retrospectively identified who underwent both a XR-KUB and a low dose CT-KUB in 2018. Effective-Dose (utilised as a numerical measure of overall risk to a patient from imaging modalities) was measured by converting the recorded “Dose Area/Length Product” via the standardised ICRP formula. RESULTS: The average Effective-Dose for XR-KUBs was 5.10mSv [Range:0.8-42.4]. CT-KUBs was 5.31mSv [Range:1.4–30.5]. 18/53 (34%) of patients underwent XR-KUBs with higher Effective-Dose levels than their CT-KUB. Patients with higher Weight, BMI and AP diameter had higher Effective-Doses for both their XR and CT-KUBs. Patients weighing more than 92kg or had a BMI greater than 32 all had a XR-KUBs with a higher Effective-Dose than their CT-KUB. CONCLUSIONS: For the first time in the UK, we have found that the Effective-Dose of XR-KUB was on average 5-fold higher than historically referenced. Furthermore, for 1-in-3 patients, the radiation Effective-Dose of their CT-KUBs was less than their XR-KUB. This is particularly true in patients with BMI over 32 and weight over 92kg. Given the higher than expected radiation dose associated with XR-KUBs and its’ limited sensitivity/considering alternative imaging modalities such as Ultrasound-KUB or the implementation of “ultra-low dose” CT KUBs where the Effective-Dose is reported to be as low as 1.9 mSv. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e528-e528 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bob Yang* More articles by this author Noorunisa Suhail More articles by this author Johan Marais More articles by this author Thomas Reeves More articles by this author Mostafa Ragab More articles by this author Alister Campbell More articles by this author Mohammed ElSaghir More articles by this author Melissa Davies More articles by this author James Brewin More articles by this author Expand All Advertisement PDF downloadLoading ...

Background Spinal cord injury (SCI) patients are at increased risk of developing urolithiasis. Ureteroscopic management for stone disease in SCI patients is underreported. Endourologists face many challenges in the management of stone disease in SCI patients including decreased stone free rates (SFR), increased infection risk, increased complication rate, anatomical variation, increased comorbidity level and challenges to nursing care. We present our experience at a regional SCI centre. Methods Retrospective data was collected from 2005-2017 from a single SCI unit for patients who underwent ureteroscopy for stone disease. Results A total of 21 patients underwent 41 procedures, 7 cases being a planned multi-stage approach. Bladder management included sheath catheter, urethral catheter, suprapubic catheter, intermittent self-catheterisation, mitrofanoff, and ileal conduit. Spinal cord level was cervical (71%) or thoracic (29%), with American Spinal Injury Association (ASIA) grade classification A (86%), C (9%) and D (5%). Median follow-up time for patients was 46 months. Average stone size was 27 mm (range, 5-59 mm) access was achieved 98% of patients, with an access sheath used in 63%. The SFR was 47% with a recurrence rate (RR) of 42%. The complication rate was 24% all being Clavien Dindo grade 2. Conclusions Ureteroscopy in SCI can be challenging and careful multidisciplinary team planning for intervention is needed. Ureteroscopy offers a useful treatment option for SCI, however, is associated with a lower SFR and greater complication rate compared to that of the general population.

Background: Spinal cord injury (SCI) patients are at increased risk of developing urolithiasis. Ureteroscopic management for stone disease in SCI patients is underreported. Endourologists face many challenges in the management of stone disease in SCI patients including decreased stone free rates (SFR), increased infection risk, increased complication rate, anatomical variation, increased comorbidity level and challenges to nursing care. We present our experience at a regional SCI centre. Methods: Retrospective data was collected from 2005-2017 from a single SCI unit for patients who underwent ureteroscopy for stone disease. Results: A total of 21 patients underwent 41 procedures, 7 cases being a planned multi-stage approach. Bladder management included sheath catheter, urethral catheter, suprapubic catheter, intermittent selfcatheterisation, mitrofanoff, and ileal conduit. Spinal cord level was cervical (71%) or thoracic (29%), with American Spinal Injury Association (ASIA) grade classification A (86%), C (9%) and D (5%). Median followup time for patients was 46 months. Average stone size was 27 mm (range, 5-59 mm) access was achieved 98% of patients, with an access sheath used in 63%. The SFR was 47% with a recurrence rate (RR) of 42%. The complication rate was 24% all being Clavien Dindo grade 2. Conclusions: Ureteroscopy in SCI can be challenging and careful multidisciplinary team planning for intervention is needed. Ureteroscopy offers a useful treatment option for SCI, however, is associated with a lower SFR and greater complication rate compared to that of the general population.

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment II1 Apr 2017PD41-03 VALIDATION OF THE EUROPEAN SIMULATE URETERORENOSCOPY TRAINING CURRICULUM Abdullatif Aydin, Kamran Ahmed, Takashige Abe, Thomas Kunit, Nicholas Raison, Oliver Brunckhorst, Thomas Wood, Talisa Ross, Karl-Dietrich Sievert, Muhammad Shamim Khan, and Prokar Dasgupta Abdullatif AydinAbdullatif Aydin More articles by this author , Kamran AhmedKamran Ahmed More articles by this author , Takashige AbeTakashige Abe More articles by this author , Thomas KunitThomas Kunit More articles by this author , Nicholas RaisonNicholas Raison More articles by this author , Oliver BrunckhorstOliver Brunckhorst More articles by this author , Thomas WoodThomas Wood More articles by this author , Talisa RossTalisa Ross More articles by this author , Karl-Dietrich SievertKarl-Dietrich Sievert More articles by this author , Muhammad Shamim KhanMuhammad Shamim Khan More articles by this author , and Prokar DasguptaProkar Dasgupta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1882AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent developments in surgical education suggest that training using a range of simulators of different modalities, within a curriculum, may be much more effective. Furthermore, emphasis must also be placed on nontechnical skills training. The aim of this study is to assess the face, content, construct and transfer components of validity of the newly-developed SIMULATE ureterorenoscopy (URS) training curriculum. METHODS A comprehensive training curriculum was developed by experts (n=21) and residents (n=25) using the Delphi process. The curriculum consists of virtual reality, dry-lab and full immersion simulation modalities. Upon completion, 30 residents were invited for training using the curriculum on two separate occasions in the UK (n=15) and Austria (n=15). The former cohort were also given the opportunity to use fresh frozen cadavers with fluoroscopy. Participants were taught and assessed, using OSATS, by endourology and education specialists, all of whom were also invited for an evaluation survey following the training program. Construct validity was assessed using a One-way ANOVA test to evaluate the level of progress throughout the training. Residents were followed up at their institutions and assessed for technical skills, using OSATS, and nontechnical skills, using a modified NOTSS score for URS on their first (n=12) and fourth (n=11) cases to evaluate transfer validity. RESULTS Participants rated that the training significantly improved their skills (mean: 4.2/5) and that they gained transferrable skills (mean: 4.2/5). A One-way ANOVA test revealed significant improvement in both semi-rigid URS (p<0.0001) and flexible URS (p=0.0003) skills, with consecutive cases throughout the course of the curriculum and the first operating room performance (n=12). Statistically significant improvement was observed in non-technical skills from between the training and first operating room performance (p<0.0001). Of the used modalities, flexible URS (mean: 4.3/5) and stone fragmentation (mean: 4.3/5) were rated to be the strongest aspects of the UroMentor. In contrast, both the dry-lab models scored the highest with regards to instrument handling, laser stone fragmentation and stone extraction. C-arm control was the most highly rated aspect of fresh frozen cadavers (mean: 4.7/5). CONCLUSIONS The SIMULATE URS curriculum revealed face, content, construct and validity. Participants are currently being followed up in the operating room for 25 URS procedures and will compared to an arm with no simulation experience, as part of the on-going SIMULATE randomised controlled trial. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e807-e808 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Abdullatif Aydin More articles by this author Kamran Ahmed More articles by this author Takashige Abe More articles by this author Thomas Kunit More articles by this author Nicholas Raison More articles by this author Oliver Brunckhorst More articles by this author Thomas Wood More articles by this author Talisa Ross More articles by this author Karl-Dietrich Sievert More articles by this author Muhammad Shamim Khan More articles by this author Prokar Dasgupta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment II1 Apr 2016MP20-05 DEVELOPMENT OF THE SIMULATE URETERORENOSCOPY TRAINING CURRICULUM Abdullatif Aydin, Ahmed Shafi, James Brewin, Craig McIlhenny, John McCabe, Matthew Bultitude, Jonathan Glass, Nicholas Rukin, Jake Patterson, Muhammad Shamim Khan, Prokar Dasgupta, and Kamran Ahmed Abdullatif AydinAbdullatif Aydin More articles by this author , Ahmed ShafiAhmed Shafi More articles by this author , James BrewinJames Brewin More articles by this author , Craig McIlhennyCraig McIlhenny More articles by this author , John McCabeJohn McCabe More articles by this author , Matthew BultitudeMatthew Bultitude More articles by this author , Jonathan GlassJonathan Glass More articles by this author , Nicholas RukinNicholas Rukin More articles by this author , Jake PattersonJake Patterson More articles by this author , Muhammad Shamim KhanMuhammad Shamim Khan More articles by this author , Prokar DasguptaProkar Dasgupta More articles by this author , and Kamran AhmedKamran Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2774AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Over the last two decades, increasing number of training models have been developed and validated for use in endourology. These have employed virtual reality (VR), dry-lab and wet-lab simulation modalities. Furthermore, these training models have often used been alone whilst recent developments in the literature suggest that training using different modalities within a curriculum is much more effective. Furthermore, emphasis has also been placed on training non-technical skills. Thus, the aim of this study is to develop a simulation-based training curriculum for ureterorenoscopy (URS), employing different modalities of training including VR, dry-lab, wet-lab and full immersion simulation. METHODS A review of the literature revealed the most thoroughly validated simulator and training models for URS. Curriculum development was undertaken using the Delphi process. An online survey was developed (www.surveymonkey.com) for dissemination to an expert panel. The survey described the features of each of the modalities: VR, dry-lab, cadaveric and full immersion simulation. In Round 1, residents and specialists were asked to rate the relevance of the basic tasks and cases of the VR simulator on a 5-point Likert scale. They were also asked to make suggestions for cases to be performed on the dry-lab model, cadavers and inside the full immersion simulation environment. Finally, respondents were asked to rate the order within which each modality should be utilised in the curriculum. The suggestions were used to formulate the initial curriculum. In Round 2, specialists were asked to confirm the outline of the curriculum and make suggestions where necessary. RESULTS Residents (n=25), with URS experience, and Specialists (n=21) participated in Round 1 of the Delphi process. Of all ten basic tasks on the VR simulator, four scored a mean of >4/5. Respondents selected three stones cases to be performed by beginner residents. A number of semi-rigid URS tasks were suggested for dry- and wet-lab simulation including ureteral orifice cannulation, guidewire placement, basket extraction and laser fragmentation of stones. For flexible URS, diagnostic inspection of calyces, laser stone fragmentation and basket extraction were suggested. A range of scenarios were put forward to be carried out in the Full Immersion Simulation environment (Imperial College, London, UK) including management of inexperienced teams, team briefing, management of faulty equipment and management of complications. Ten specialists confirmed the outline of the developed curriculum in Round 2, which consisted of Virtual Reality, dry-lab and cadaveric simulation. CONCLUSIONS A 2-round Delphi process was utilised to develop a simulation-based URS training curriculum for novice residents. Expert opinion and trainee experience were taken into consideration and used to confirm the final outline of the curriculum. The curriculum consists of different modalities of simulation as well as non-technical skills training, but requires formal validation. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e214 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Abdullatif Aydin More articles by this author Ahmed Shafi More articles by this author James Brewin More articles by this author Craig McIlhenny More articles by this author John McCabe More articles by this author Matthew Bultitude More articles by this author Jonathan Glass More articles by this author Nicholas Rukin More articles by this author Jake Patterson More articles by this author Muhammad Shamim Khan More articles by this author Prokar Dasgupta More articles by this author Kamran Ahmed More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment II1 Apr 2016MP20-04 DEVELOPMENT AND VALIDATION OF A URETERORENOSCOPY NON-TECHNICAL SKILLS CURRICULUM Abdullatif Aydin, Oliver Brunckhorst, Haleema Aya, David Eldred-Evans, Ahmed Al-Jabir, James Brewin, Craig McIlhenny, Muhammad Shamim Khan, Prokar Dasgupta, and Kamran Ahmed Abdullatif AydinAbdullatif Aydin More articles by this author , Oliver BrunckhorstOliver Brunckhorst More articles by this author , Haleema AyaHaleema Aya More articles by this author , David Eldred-EvansDavid Eldred-Evans More articles by this author , Ahmed Al-JabirAhmed Al-Jabir More articles by this author , James BrewinJames Brewin More articles by this author , Craig McIlhennyCraig McIlhenny More articles by this author , Muhammad Shamim KhanMuhammad Shamim Khan More articles by this author , Prokar DasguptaProkar Dasgupta More articles by this author , and Kamran AhmedKamran Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2773AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Considerable attention has been given to the development of simulation-based technical skills training. Although several studies have illustrated the importance of non-technical skills training, this area is often overlooked in many surgical specialties. The aim of this study is to develop and validate an ureterorenoscopy procedure-specific non-technical skills curriculum for junior urology residents. METHODS A Delphi technique was employed to consult experts in urolithiasis and non-technical skills training and determine the contents and scenarios for the curriculum. Fourteen junior urology residents from around the United Kingdom were invited to participate in a one-day training session. Participants were divided into four groups, with up to four in each group. Four independent scenarios were conducted within the previously validated Full Immersion Simulation environment (Imperial College, London, UK). Two faculty members, with expertise in urolithiasis and non-technical skills training, supervised participants. Faculty and the remaining participants in each group observed the sessions through a video-link. Each candidate was given individual feedback and assessed using a modified Non-technical Skills for Surgeons (NOTSS) rating scale for ureterorenoscopy. Sessions were concluded with an evaluation questionnaire. RESULTS The following four scenarios were conducted during the session: briefing the emergency theatre team (n=4), management of a patient with septic stone (n=4), interacting with an inexperienced member of staff (n=4) and management of faulty instrumentation (n=2). A significant majority stated that they felt they were in the real operating room (mean: 4.5/5), behaved as they did in real operations (mean: 4.4/5) and that the team interactions were realistic (mean: 4.6/5). Participants rated the day to be very useful (mean: 4.7/5), stated that it significantly improved their technical (mean: 4.1/5) and non-technical skills (mean: 4.6/5) and added that this form of simulation adds value to simulation-based training (mean: 4.8/5). It was also felt that the session provided them with transferrable skills, which can be taken into the operating room (mean: 4.8/5). A One-way ANOVA test revealed significant improvement in non-technical skills with consecutive scenarios (p=0.0037) in each group. CONCLUSIONS The non-technical skills curriculum for ureterorenoscopy revealed to be useful for junior urology residents. Both participants and faculty rated the programme highly in all parameters, demonstrating educational value and acceptability. The participants will be followed in their individual institutions for transfer validity. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e213-e214 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Abdullatif Aydin More articles by this author Oliver Brunckhorst More articles by this author Haleema Aya More articles by this author David Eldred-Evans More articles by this author Ahmed Al-Jabir More articles by this author James Brewin More articles by this author Craig McIlhenny More articles by this author Muhammad Shamim Khan More articles by this author Prokar Dasgupta More articles by this author Kamran Ahmed More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

OBJECTIVE: Little integration of technical and nontechnical skills (e.g., situational awareness, communication, decision making, teamwork, and leadership) teaching exists within surgery. We therefore aimed to (1) evaluate the relationship between these 2 skill sets within a simulation-based environment and (2) assess if certain nontechnical skill components are of particular relevance to technical performance.DESIGN: A prospective analysis of data acquired from a comparative study of simulation vs nonsimulation training was conducted. Half of the participants underwent training of technical and nontechnical skills within ureteroscopy, with the remaining half undergoing no training. All were assessed within a full immersion environment against both technical (time to completion, Objective Structured Assessment of Technical Skills, and task-specific checklist scores) and nontechnical parameters (Nontechnical Skills for Surgeons [NOTSS] rating scale). The data of whole and individual cohorts were analyzed using Pearson correlation coefficient.SETTING: The trial took place within the Simulation and Interactive Learning Centre at Guy's Hospital, London, UK.PARTICIPANTS: In total, 32 novice participants with no prior practical ureteroscopy experience were included within the data analysis.RESULTS: A correlation was found within all outcome measures analyzed. For the whole cohort, a strong negative correlation was found between time to completion and NOTSS scores (r = -0.75, p < 0.001), with strong positive correlations identified when NOTSS scores were compared with Objective Structured Assessment of Technical Skills (r = 0.89, p < 0.001) and task-specific checklist scores (r = 0.91, p < 0.001). Similar results were observed when each cohort was analyzed separately. Finally, all individual nontechnical skill components demonstrated a strong correlation with all technical skill parameters, regardless of training.CONCLUSIONS: A strong correlation between technical and nontechnical performance exists, which was demonstrated to be irrespective of training received. This may suggest an inherent link between skill sets. Furthermore, all nontechnical skill sets are important in technical performance. This supports the notion that both of these skills should be trained and assessed together within 1 curriculum. (C) 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Calcific uremic arteriolopathy or calciphylaxis is a rare condition that can present with clinical features similar to penile cancer. It is a diagnosis to consider in patients with end-stage renal failure (ESRF) presenting with a penile lesion. We describe one such case, where a patient with ESRF presented with a solid, tender penile mass and underwent surgery for presumed penile cancer. Histopathological analysis however confirmed a diagnosis of calcific uremic arteriolopathy, without evidence of malignancy. The clinical diagnosis of calcific uremic arteriolopathy relies on a high index of suspicion, and lesion biopsy is controversial due to a high risk of poor wound healing and sepsis. New treatment options are encouraging, and have been reported, albeit in small numbers. Delayed diagnosis can adversely affect both quality of life and prognosis in a condition with an extremely high mortality rate.

Current training modalities within ureteroscopy have been extensively validated and must now be integrated within a comprehensive curriculum. Additionally, non-technical skills often cause surgical error and little research has been conducted to combine this with technical skills teaching. This study therefore aimed to develop and validate a curriculum for semi-rigid ureteroscopy, integrating both technical and non-technical skills teaching within the programme.

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment II1 Apr 2015MP23-05 IS THERE A CORRELATION BETWEEN TECHNICAL SKILLS AND NON-TECHNICAL SKILLS PERFORMANCE WITHIN URETEROSCOPY? Oliver Brunckhorst, Shahab Shahid, Abdullatif Aydin, Craig McIlhenny, Shahid Khan, Arun Sahai, James Brewin, Fernando Bello, Roger Kneebone, Muhammad Khan, Prokar Dasgupta, and Kamran Ahmed Oliver BrunckhorstOliver Brunckhorst More articles by this author , Shahab ShahidShahab Shahid More articles by this author , Abdullatif AydinAbdullatif Aydin More articles by this author , Craig McIlhennyCraig McIlhenny More articles by this author , Shahid KhanShahid Khan More articles by this author , Arun SahaiArun Sahai More articles by this author , James BrewinJames Brewin More articles by this author , Fernando BelloFernando Bello More articles by this author , Roger KneeboneRoger Kneebone More articles by this author , Muhammad KhanMuhammad Khan More articles by this author , Prokar DasguptaProkar Dasgupta More articles by this author , and Kamran AhmedKamran Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1248AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A surgeon requires much more than just good technical skills, with non-technical skills being a common cause of error. These two skillsets are unfortunately often seen as separate entities, however we hypothesize that they are in fact not independent of each other. We therefore aimed to evaluate the relationship between technical and non-technical skills performance within ureteroscopy and if any particular subset of non-technical skills appears to be more important. METHODS A prospective analysis of data acquired from a comparative study of simulation vs. non-simulation training (knowledge only) was conducted. In total 32 novices were included, half of which underwent formal training for both technical and non-technical skillsets with the remaining half underwent none. All were assessed within a fully immersive environment in a standardised ureteroscopy case. Both technical and non-technical outcome measures were utilised, assessing both skillsets. Pearson's correlation coefficient was used to analyse the relationship between outcome measures. RESULTS All outcome measures demonstrated a significant correlation. Time to completion within the whole cohort demonstrated a strong negative correlation with NOTSS scores (r = -0.50, p<0.001). Also, strong positive relationships were present within whole cohort OSATS (r = 0.89, p<0.001) and task specific checklist scores (r = 0.91, p<0.001). When the cohort without training was analyased separately a demonstrated a strong correlation with NOTSS scores when compared to the time to completion (r = -0.5, p<0.05), OSATS (r = 0.80, p<0.001) and task specific checklist scores (r = 0.87, p<0.001) was still present. Finally, subsets of non-technical skills such as situational awareness, decision-making, communication and leadership, all demonstrated a strong correlation with all of the technical skills components with all r scores larger than 0.60 and p <0.001. CONCLUSIONS We conclude that a strong relationship between technical skills and non-technical skills is present. This relationship was demonstrated to be regardless of training and therefore inherent. Additionally, no identified subset of non-technical skills is best correlated with technical skills performance, demonstrating how crucial all skillsets are. The demonstration of the correlation between these skillsets shows how these two skills should not be treated as separate entities, but instead should be trained and assessed together. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e268-e269 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Metrics Author Information Oliver Brunckhorst More articles by this author Shahab Shahid More articles by this author Abdullatif Aydin More articles by this author Craig McIlhenny More articles by this author Shahid Khan More articles by this author Arun Sahai More articles by this author James Brewin More articles by this author Fernando Bello More articles by this author Roger Kneebone More articles by this author Muhammad Khan More articles by this author Prokar Dasgupta More articles by this author Kamran Ahmed More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

OBJECTIVE:To evaluate the face, content and construct validity of the distributed simulation (DS) environment for technical and non-technical skills training in endourology. To evaluate the educational impact of DS for urology training. SUBJECTS AND METHODS:DS offers a portable, low-cost simulated operating room environment that can be set up in any open space. A prospective mixed methods design using established validation methodology was conducted in this simulated environment with 10 experienced and 10 trainee urologists. All participants performed a simulated prostate resection in the DS environment. Outcome measures included surveys to evaluate the DS, as well as comparative analyses of experienced and trainee urologist's performance using real-time and 'blinded' video analysis and validated performance metrics. Non-parametric statistical methods were used to compare differences between groups. RESULTS:The DS environment demonstrated face, content and construct validity for both non-technical and technical skills. Kirkpatrick level 1 evidence for the educational impact of the DS environment was shown. Further studies are needed to evaluate the effect of simulated operating room training on real operating room performance. CONCLUSIONS:This study has shown the validity of the DS environment for non-technical, as well as technical skills training. DS-based simulation appears to be a valuable addition to traditional classroom-based simulation training.

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment I1 Apr 2015MP22-09 DEVELOPMENT AND VALIDATION OF AN INTEGRATED SKILLS CURRICULUM WITHIN URETEROSCOPY– A RANDOMISED CONTROLLED TRIAL Oliver Brunckhorst, Shahab Shahid, Abdullatif Aydin, Craig McIlhenny, Shahid Khan, Syed Raza, Arun Sahai, James Brewin, Fernando Bello, Roger Kneebone, Muhammad Khan, Prokar Dasgupta, and Kamran Ahmed Oliver BrunckhorstOliver Brunckhorst More articles by this author , Shahab ShahidShahab Shahid More articles by this author , Abdullatif AydinAbdullatif Aydin More articles by this author , Craig McIlhennyCraig McIlhenny More articles by this author , Shahid KhanShahid Khan More articles by this author , Syed RazaSyed Raza More articles by this author , Arun SahaiArun Sahai More articles by this author , James BrewinJames Brewin More articles by this author , Fernando BelloFernando Bello More articles by this author , Roger KneeboneRoger Kneebone More articles by this author , Muhammad KhanMuhammad Khan More articles by this author , Prokar DasguptaProkar Dasgupta More articles by this author , and Kamran AhmedKamran Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1021AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Within ureteroscopy various training modalities have been developed, however for best utilization these must be utilised within a structured curriculum. Additionally, non-technical skills are a common cause of surgical errors but these are often not integrated with technical skills teaching. We therefore aimed to develop and evaluate a simulation-based ureteroscopy curriculum that combined technical and non-technical skills training and assessment. METHODS Delphi methodology with six experts was used for the development of the curriculum. A virtual reality, bench top and full immersion training modality were incorporated within the curriculum to teach both skillsets together. Evaluation of the curriculum was conducted via a randomised trial of 32 medical students. Sixteen participants underwent the full simulation-based curriculum with the other sixteen acting as controls. Assessment then took place within the full immersion environment to assess both skillsets. Video analysis of the participants performance was performed by two blinded assessors. All participants then filled out post-study questionnaires. RESULTS Both technical and non-technical skills were improved within the intervention cohort. They performed the task in less time (933 vs. 1617 seconds, p<0.001) with two objective rating scales demonstrating significantly better technical skills (OSATS = 23.5 vs. 14.8, p<0.001 and task specific checklist scores = 73.4 vs. 60.4, p=0.011). Non-technical skills were improved as demonstrated by increased NOTSS scores (13.1 vs. 9.1, p<0.001). Additionally, content validation was achieved via the development process with both acceptability and feasibility shown through post-study questionnaire results. CONCLUSIONS Simulation-based training must not rely on individual use of models but instead should be used within a comprehensive curriculum. The present study demonstrates such a validated curriculum within ureteroscopy. Additionally, this study demonstrates that integrating technical and non-technical skills teaching and assessment within one training pathway feasible and educational. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e244-e245 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Oliver Brunckhorst More articles by this author Shahab Shahid More articles by this author Abdullatif Aydin More articles by this author Craig McIlhenny More articles by this author Shahid Khan More articles by this author Syed Raza More articles by this author Arun Sahai More articles by this author James Brewin More articles by this author Fernando Bello More articles by this author Roger Kneebone More articles by this author Muhammad Khan More articles by this author Prokar Dasgupta More articles by this author Kamran Ahmed More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...