MRC Centre for Transplantation, King's College London, King's Health Partners, Department of Urology, Guy's Hospital, London, UK.
BJU Int. 2013 Mar;111(3):518-23. doi: 10.1111/j.1464-410X.2012.11204.x. Epub 2012 Aug 29.
WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: A competent urologist should not only have effective technical skills, but also other attributes that would make him/her a complete surgeon. These include team-working, communication and decision-making skills. Although evidence for effectiveness of simulation exists for individual simulators, there is a paucity of evidence for utility and effectiveness of these simulators in training programmes that aims to combine technical and non-technical skills training. This article explains the process of development and validation of a centrally coordinated simulation program (Participants - South-East Region Specialist Registrars) under the umbrella of the British Association for Urological Surgeons (BAUS) and the London Deanery. This program incorporated training of both technical (synthetic, animal and virtual reality models) and non-technical skills (simulated operating theatres).
To establish the feasibility and acceptability of a centralized, simulation-based training-programme. Simulation is increasingly establishing its role in urological training, with two areas that are relevant to urologists: (i) technical skills and (ii) non-technical skills.
For this London Deanery supported pilot Simulation and Technology enhanced Learning Initiative (STeLI) project, we developed a structured multimodal simulation training programme. The programme incorporated: (i) technical skills training using virtual-reality simulators (Uro-mentor and Perc-mentor [Symbionix, Cleveland, OH, USA], Procedicus MIST-Nephrectomy [Mentice, Gothenburg, Sweden] and SEP Robotic simulator [Sim Surgery, Oslo, Norway]); bench-top models (synthetic models for cystocopy, transurethral resection of the prostate, transurethral resection of bladder tumour, ureteroscopy); and a European (Aalborg, Denmark) wet-lab training facility; as well as (ii) non-technical skills/crisis resource management (CRM), using SimMan (Laerdal Medical Ltd, Orpington, UK) to teach team-working, decision-making and communication skills. The feasibility, acceptability and construct validity of these training modules were assessed using validated questionnaires, as well as global and procedure/task-specific rating scales.
In total 33, three specialist registrars of different grades and five urological nurses participated in the present study. Construct-validity between junior and senior trainees was significant. Of the participants, 90% rated the training models as being realistic and easy to use. In total 95% of the participants recommended the use of simulation during surgical training, 95% approved the format of the teaching by the faculty and 90% rated the sessions as well organized. A significant number of trainees (60%) would like to have easy access to a simulation facility to allow more practice and enhancement of their skills.
A centralized simulation programme that provides training in both technical and non-technical skills is feasible. It is expected to improve the performance of future surgeons in a simulated environment and thus improve patient safety.
确定集中式基于模拟的培训计划的可行性和可接受性。模拟在泌尿科培训中越来越多地确立了其地位，与泌尿科医生相关的有两个方面：（i）技术技能和（ii）非技术技能。
对于这个伦敦教务长支持的试点模拟和技术增强学习计划（STeLI）项目，我们开发了一个结构化的多模式模拟培训计划。该计划包括：（i）使用虚拟现实模拟器（Uro-mentor 和 Perc-mentor [Symbionix，克利夫兰，俄亥俄州，美国]、Procedicus MIST-Nephrectomy [Mentice，哥德堡，瑞典]和 SEP 机器人模拟器 [Sim Surgery，奥斯陆，挪威]）进行技术技能培训；（ii）使用 SimMan（Laerdal Medical Ltd，奥平顿，英国）进行非技术技能/危机资源管理（CRM）培训，以教授团队合作、决策和沟通技巧。使用经过验证的问卷以及总体和程序/任务特定的评分量表评估这些培训模块的可行性、可接受性和结构有效性。
共有 33 名不同级别和 5 名泌尿科护士的专科住院医师参加了本研究。初级和高级学员之间的结构有效性具有统计学意义。90%的参与者认为培训模型具有现实性和易用性。共有 95%的参与者推荐在手术培训中使用模拟，95%的参与者赞成教员的教学形式，90%的参与者对课程的组织评价良好。相当数量的学员（60%）希望能够方便地获得模拟设施，以便进行更多的练习和技能提升。
提供技术和非技术技能培训的集中式模拟计划是可行的。预计它将提高未来外科医生在模拟环境中的表现，从而提高患者安全性。
