Training in endourology - the role of simulators
J.M.C.H. de la Rosette MD Ph.D., European Urology Today, June 2001

The changing face of EndoUrology training received special attention at the EAU Congress with an exhibition of a new computerized, interactive EndoUrology simulator in the Technology Garden

Both in past and present training in EndoUrology has focused primarily on three stages of learning. Stage one entails the review of textual material on the urinary collecting system anatomy and on the procedures involved in diagnostic and therapeutic activities. In addition to the library work, trainees may view video films, where available, of actual procedures, which have been performed on patients. Stage two has the trainee present at actual procedures where he may observe the techniques required for performance of endourology procedures. And, the third stage involves the performance by the trainee of actual procedures on patients while under the supervision of a specialist during the entire procedure.

More recently in some programs the three-staged training may be supplemented by the use of mechanical or animal simulators. The mechanical simulators have a very short-term usefulness in familiarizing the trainee with the anatomy. The animal simulators are useful in providing a more true-to-life feel, however are problematic from both the point of view of the use of animals for this purpose and the time and cost of setting up an animal simulator workshop. Yet, both have the benefit of providing the trainee with an opportunity to gain the hand-eye coordination and the skills required for endourological procedures without risk to the patient. The new generation of EndoUrology training simulators, which are now becoming available address the issues of patient safety, cost effectiveness, gaining of skills and more.

Instructors may find that their trainees spend more time on performing procedures while they spend a good deal less time supervising them. The teaching of a difficult procedure will no longer be dependent upon finding a patient suffering from that particular problem. With the URO Mentor simulator the instructor may select any case desired as well as any number of cases or repetitions of cases. Computerized simulators employing the latest in video imaging and sensor technology, give medical experts and trainees the opportunity to practice procedures from the most basic to both the rare and difficult without risk to patients and without the need for animals or animal parts. The practice venue is readily available at all times.

During the presentation and demo at the EAU meeting in Geneva, it was shown how performance evaluation is also improved via the new simulators. Video recording of performed procedures, and computer tracking of performance time provide the instructor with objective means for trainee evaluation as well as information over time, which enables the tracking of trainee improvement. Even the trainee may follow his own progress and identify areas in which he may choose to engage in additional practice. And, the opportunity to practice is as available as is time on the simulator.

The new simulators provide the trainee with an amazingly true-to-life experience. Within minutes he may find himself immersed in an actual patient case, performing a procedure on the simulator mannequin, having forgotten the fact that his patient, though quite sophisticated, is far from flesh and blood. The images he sees on the video monitor are the same as those he would see in an actual procedure room in the hospital. And yet, the beginning trainee may rest assured that he can't hurt anyone if his skills are not yet up to far.

Attendees at the XVI Congress of the European Association of Urology also had the opportunity to try out the new EndoUrology Training Simulator at the Technological Garden booth, which proved to be a popular addition to the congress this year attracting large numbers of visitors. Simulators such as the URO Mentor will undoubtedly soon play expanding roles in endourology training. The ability to design a tailor made training program, to assign cases to trainees on a remote basis, and to review the computerized evaluation and record of performance make the simulator an invaluable part of any training, accreditation or CME program.

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