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  • Review Article
  • Published:

Simulation-based training and assessment in urological surgery

Nature Reviews Urology volume 13, pages 503–519 (2016)Cite this article

Subjects

This article has been updated

Key Points

  • The largest number of urological training simulators have been produced for training in endourology; these models are also the most robustly evaluated, with the URO Mentor (Symbionix, USA) holding the highest level of evidence

  • Despite great numbers of generic skills simulators, laparoscopic and robotic procedural models are few in number

  • Development of models for open urological surgery has been limited, with currently available models supported by only low levels of evidence

  • A number of curricula have been produced, incorporating various different training modalities and nontechnical skills, with the aim of optimizing simulation training

  • Patient-specific simulation — in the form of virtual reality (VR) simulators and 3D-printed models — is on the increase, which could prove to be useful in anticipation of complex cases

  • A curriculum for training in urological techniques is recommended

Abstract

Simulation has become widely accepted as a supplementary method of training. Within urology, the greatest number of procedure-specific models and subsequent validation studies have been carried out in the field of endourology. Many generic-skills simulators have been created for laparoscopic and robot-assisted surgery, but only a limited number of procedure-specific models are available. By contrast, open urological simulation has only seen a handful of validated models. Of the available modalities, virtual reality (VR) simulators are most commonly used for endourology and robotic surgery training, the former also employing many high-fidelity bench models. Smaller dry-lab and ex vivo animal models have been used for laparoscopic and robotic training, whereas live animals and human cadavers are widely used for full procedural training. Newer concepts such as augmented-reality (AR) models and patient-specific simulators have also been introduced. Several curricula, including one recommended within, have been produced, incorporating various different training modalities and nontechnical skills training techniques. Such curricula and validated models should be used in a structured fashion to supplement operating room training.

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Figure 1: Components of nontechnical skills.
Figure 2: Recommended simulation training pathway.

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Change history

  • 31 August 2016

    In the version of this article initially published online the corresponding author was incorrect. The correct corresponding author is Prokar Dasgupta. This error has been corrected for the HTML, PDF and print versions of the article.

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Authors and Affiliations

  1. MRC Centre for Transplantation, King's College London, 5th Floor Southwark Wing, Guy's Hospital, London, SE1 9RT, UK

    Abdullatif Aydin, Nicholas Raison, Muhammad Shamim Khan, Prokar Dasgupta & Kamran Ahmed

  2. The Urology Centre, Guy's and St Thomas' NHS Foundation Trust, 1st Floor Southwark Wing, Guy's Hospital, London, SE1 9RT, UK

    Muhammad Shamim Khan, Prokar Dasgupta & Kamran Ahmed

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  1. Abdullatif Aydin
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Contributions

A.A. and N.R. researched data for the article and wrote the manuscript. All authors contributed to discussions of content and reviewed or edited the article before submission.

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Correspondence to Prokar Dasgupta.

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Glossary

Full immersion simulation

An inflatable low-fidelity and highly immersive operating room environment utilised for technical and nontechnical skills training.

High-fidelity operating room simulation

Simulation-based technical and nontechnical skills training in a dedicated high-fidelity operating room.

Acceptability

The extent to which a training tool or assessment procedure is accepted by the subjects involved in the assessment.

Educational impact

The extent to which test results and feedback contribute to improve the learning strategy on behalf of the trainer and the trainee

Cost effectiveness

The extent to which a training and assessment tool provides maximum value for money.

Crisis resource management training

(CRM training). Simulation training to enhance cognitive, interpersonal, communication and team-working skills during emergency scenarios.

Feasibility

The extent to which a training and assessment process is capable of being carried out.

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Aydin, A., Raison, N., Khan, M. et al. Simulation-based training and assessment in urological surgery. Nat Rev Urol 13, 503–519 (2016). https://doi.org/10.1038/nrurol.2016.147

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