Department of Urology, Division of Female Urology, Pelvic Reconstruction Surgery & Voiding Dysfunction University of California, Irvine, California.
Department of Urology, Division of Female Urology, Pelvic Reconstruction Surgery & Voiding Dysfunction University of California, Irvine, California.
J Surg Educ. 2018 Nov;75(6):1673-1678. doi: 10.1016/j.jsurg.2018.04.011. Epub 2018 May 3.
Endoscopic injection of urethral bulking agents is an office procedure that is used to treat stress urinary incontinence secondary to internal sphincteric deficiency. Validation studies important part of simulator evaluation and is considered important step to establish the effectiveness of simulation-based training. The endoscopic needle injection (ENI) simulator has not been formally validated, although it has been used widely at University of California, Irvine. We aimed to assess the face, content, and construct validity of the UC, Irvine ENI simulator.
Dissected female porcine bladders were mounted in a modified Hysteroscopy Diagnostic Trainer. Using routine endoscopic equipment for this procedure with video monitoring, 6 urologists (experts group) and 6 urology trainee (novice group) completed urethral bulking agents injections on a total of 12 bladders using ENI simulator. Face and content validities were assessed by using structured quantitative survey which rating the realism. Construct validity was assessed by comparing the performance, time of the procedure, and the occlusive (anatomical and functional) evaluations between the experts and novices. Trainees also completed a postprocedure feedback survey. Effective injections were evaluated by measuring the retrograde urethral opening pressure, visual cystoscopic coaptation, and postprocedure gross anatomic examination.
All 12 participants felt the simulator was a good training tool and should be used as essential part of urology training (face validity). ENI simulator showed good face and content validity with average score varies between the experts and the novices was 3.9/5 and 3.8/5, respectively. Content validity evaluation showed that most aspects of the simulator were adequately realistic (mean Likert scores 3.9-3.8/5). However, the bladder does not bleed, and sometimes thin. Experts significantly outperformed novices (p < 001) across all measure of performance therefore establishing construct validity.
The ENI simulator shows face, content and construct validities, although few aspects of simulator were not very realistic (e.g., bleeding).This study provides a base for the future formal validation for this simulator and for continuing use of this simulator in endourology training.
经尿道注射尿道膨体物是一种在办公室进行的程序，用于治疗因内括约肌缺陷导致的压力性尿失禁。验证研究是模拟器评估的重要组成部分，被认为是建立模拟培训有效性的重要步骤。尽管加利福尼亚大学欧文分校已经广泛使用内窥镜针注射（ENI）模拟器，但它尚未经过正式验证。我们旨在评估 UCI ENI 模拟器的表面、内容和构建有效性。
将解剖的雌性猪膀胱安装在改良的宫腔镜诊断训练器上。使用该程序的常规内窥镜设备和视频监测，6 名泌尿科医生（专家组）和 6 名泌尿科住院医师（新手组）共使用 ENI 模拟器对 12 个膀胱进行了尿道膨体物注射。通过使用结构化定量调查评估表面和内容有效性，该调查对逼真度进行评分。通过比较专家和新手的操作、手术时间和闭塞（解剖和功能）评估来评估构建有效性。住院医师还完成了手术后的反馈调查。通过测量逆行尿道开口压力、视觉膀胱镜贴合和手术后大体解剖检查来评估有效的注射。
所有 12 名参与者都认为模拟器是一种很好的培训工具，应该作为泌尿科培训的重要组成部分（表面有效性）。ENI 模拟器具有良好的表面和内容有效性，专家和新手的平均评分为 3.9/5 和 3.8/5。内容有效性评估显示，模拟器的大多数方面都具有足够的逼真度（平均李克特评分 3.9-3.8/5）。然而，膀胱不会出血，有时会很薄。专家在所有表现测量方面都明显优于新手（p < 001），因此建立了构建有效性。
ENI 模拟器具有表面、内容和构建有效性，尽管模拟器的一些方面不太逼真（例如，出血）。这项研究为该模拟器的未来正式验证以及在泌尿内镜培训中继续使用该模拟器提供了基础。
