Urological training during the COVID-19 pandemic: Our Initial Experience of TURP simulator in Singapore Residency Training and its increasing relevance for surgical skills training

Purpose: Urological training in Singapore has seen a reduction in length of training and shortened working hours to fit requirements of the residency model. Virtual reality(VR) simulators may contribute as an adjunct to shorten the learning curve and acquire surgical skills. This study assesses the construct validity of a transurethral resection of prostate(TURP) simulator and its pilot study in urological residents. Methods: The study first assessed the construct validity of the VirtaMed UroS™️ simulator with 12 novices and 12 experts. A pilot study involving 12 junior(JR) and 15 senior urology residents(SR) was then conducted. Participants were given 2 attempts to complete the same task. Performance indicators include: Percentage of prostate resected(PR), Completion time, the time that loop diathermy was active without tissue contact(TAWC), percentage of capsule resection(CR). Results: Construct validity was demonstrated: experts had significantly greater PR (40.6% vs 11.9%, p<0.05) and less TAWC than novices (0.13s vs 13.9s, p<0.05). JR demonstrated an increase in PR (13.3% vs 26.7%, p=0.0005) and a decrease in TAWC when comparing attempts (4.5s vs 1.3s, p= 0.003). Although statistically insignificant, increased PR (30.2 vs 40.5, p=0.1) and decreased TAWC (1.1 vs 0.9, p=0.84) was demonstrated when comparing attempts by SR. In the 2 nd attempt, both groups demonstrated a decrease in TAWC with JR showing a greater decrease (2.9 vs 0.4, p<0.05). Conclusion: This pilot experience shows that the TURP simulator may provide time-efficient learning to supplement urological training. Further research and incorporation of VR simulation is needed to develop more robust and comprehensive training programmes.