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Education and training evolution in urolithiasis: A perspective from European School of Urology |
Vaki Antonioua,Vineet Gauharb,Panagiotis Kallidonisc,Andreas Skolarikosc,Domenico Venezianod,Evangelo Liatsikosc,Bhaskar K. Somania,*( )
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a University Hospital Southampton, Southampton, UK b Department of Urology, Ng Teng Fong General Hospital (NUHS), Singapore, Singapore c Department of Urology, University of Patras, Greece d The Smith Institute for Urology, Northwell Health, New York, USA |
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Abstract Objective With the worldwide increase in urolithiasis prevalence, the present study aimed to delineate and summarise recent evolutions in training for the management of urolithiasis. Methods A PubMed search using the key words “simulation”, “training”, “ureteroscopy”, “RIRS”, “URS”, “percutaneous nephrolithotomy”, “PCNL”, “virtual reality”, “augmented reality”, “artificial intelligence”, “healthcare”, “curriculum”, and “assessment” was used to examine how education and training in urolithiasis have adapted over recent years. Focus was placed on the role of high- and low-fidelity simulation models, virtual reality and artificial intelligence, and standardised assessment and curriculum. Results This review supports the necessity to incorporate technology, simulation, and other skill enhancement training modalities into surgical training. However, these cannot solely replace mentored training with an experienced professional supervisor. Whilst technological and simulation advancements are likely to prove increasingly important in urolithiasis training, it is just as important for stratification of robust curricula with validated assessment. We also propose a pathway for future training. Conclusion Endourology subspeciality training programmes have successfully incorporated simulation model-based training for skill acquisition, refinement, and improving operative outcomes. Success is achieved by maintaining a delicate balance between machine and in person mentor-based training. A trainee-centred model that follows the proposed curriculum could aid this balance for the future generation of trainees.
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Received: 01 October 2022
Available online:
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Corresponding Authors:
Bhaskar K. Somani
E-mail: bhaskarsomani@yahoo.com
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Training methodology | Advantage | Disadvantage | Low-fidelity simulator | ·? Portable ·? Cheap ·? Reusable (e.g., K-box) ·? Appropriate for learning key surgical techniques in a safe environment | ·? Often do not replicate the same anatomy as in humans ·? Often unable to replicate all steps in a procedure ·? Still require senior support for feedback | High-fidelity simulator | ·? Can more closely replicate human anatomy than their low-fidelity counterparts ·? Can be used to replicate all steps in a procedure | ·? Expensive ·? Non-reusable (e.g., cadaveric models) ·? Still require senior support for feedback | Artificial intelligence | ·? Ability to give real-time, accurate feedback ·? Reproducible | ·? Expensive | Virtual reality | ·? Can reproduce varying human anatomy to high accuracy ·? Ability to give real-time, accurate feedback ·? Reusable ad infinitum | ·? Expensive ·? Lack of haptic feedback | Curriculum | ·? Standardised scoring ·? Better constructive criticism ·? Widespread usage | ·? Different learning styles or techniques cannot be accommodated |
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The advantages and disadvantages of each adjunct to training.
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A proposed pathway incorporating the EST curriculum [38]. EST, endoscopic stone treatment; EST s1, EST step 1; EST s2, EST step 2; PCNL, percutaneous nephrolithotomy; VR, virtual reality; AI, artificial intelligence.
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[1] |
Lang J, Narendrula A, El-Zawahry A, Sindhwani P, Ekwenna O. Global trends in incidence and burden of urolithiasis from 1990 to 2019: an analysis of global burden of disease study data. Eur Urol Open Sci 2022;35:37-46.
|
[2] |
Ahmed K, Patel S, Aydin A, Veneziano D, van Cleynenbreugel B, G?zen AS, et al. European Association of Urology Section of Urolithiasis (EULIS) consensus statement on simulation, training, and assessment in urolithiasis. Eur Urol Focus 2018; 4:614-20.
doi: S2405-4569(17)30074-3
pmid: 28753871
|
[3] |
Patel SR, Nakada SY. The modern history and evolution of percutaneous nephrolithotomy. https://www.liebertpub.com/doi/abs/10.1089/end.2014.0287https://home.liebertpub.com/end [Internet]. [Accessed 10 December 2021].
|
[4] |
Salas E, Bowers CA, Rhodenizer L. It is not how much you have but how you use it: toward a rational use of simulation to support aviation training. Int J Aviat Psychol 2009; 8:197-208.
doi: 10.1207/s15327108ijap0803_2
|
[5] |
Biyani CS, Van Cleynenbreugel B, Mottrie A. Practical simulation in urology. 1st ed.ed. Switzerland: Springer Cham Publisher; 2022. https://doi.org/10.1007/978-3-030-88789-6.
|
[6] |
Somani B, Brouwers T, Veneziano D, G?zen A, Ahmed K, Liatsikos E, et al. Standardization in surgical education (SISE): development and implementation of an innovative training program for urologic surgery residents and trainers by the European School of Urology in collaboration with the ESUT and EULIS sections of the EAU. Eur Urol 2021; 79:433-4.
|
[7] |
Bradley P. The history of simulation in medical education and possible future directions. Med Educ 2006; 40:254-62.
doi: 10.1111/j.1365-2929.2006.02394.x
pmid: 16483328
|
[8] |
Gaba DM. The future vision of simulation in health care. Qual Saf Health Care 2004; 13:2-10.
pmid: 14757786
|
[9] |
Al-Elq AH. Simulation-based medical teaching and learning. J Fam Community Med 2010; 17:35. https://doi.org/10.4103/1319-1683.68787.
doi: 10.4103/1319-1683.68787
|
[10] |
Chikwe J, De Souza AC, Pepper JR. No time to train the surgeons: more and more reforms result in less and less time for training. BMJ Br Med J (Clin Res Ed) 2004; 328:418. https://doi.org/10.1136/BMJ.328.7437.418.
|
[11] |
Ayd?n A, Ahmed K, Abe T, Raison N, Van Hemelrijck M, Garmo H, et al. Effect of simulation-based training on surgical proficiency and patient outcomes: a randomised controlled clinical and educational trial. Eur Urol 2022; 81:385-93.
doi: 10.1016/j.eururo.2021.10.030
|
[12] |
Tokas T, Ortner G, Peteinaris A, Somani BK, Herrmann T, Nagele U, et al. Simulation training in transurethral resection/laser vaporization of the prostate; evidence from a systematic review by the European Section of Uro-Technology. World J Urol; 40:1091-1110.
doi: 10.1007/s00345-021-03886-0
|
[13] |
Sarmah P, Voss J, Ho A, Veneziano D, Somani B. Low vs. high fidelity: the importance of “realism” in the simulation of a stone treatment procedure. Curr Opin Urol 2017; 27:316-22.
doi: 10.1097/MOU.0000000000000401
|
[14] |
Matsumoto ED, Hamstra SJ, Radomski SB, Cusimano MD. The effect of bench model fidelity on endourological skills: a randomized controlled study. J Urol 2002; 167:1243-7.
pmid: 11832706
|
[15] |
Villa L, Somani BK, Sener TE, Cloutier J, Cloutier J, Butticè F, et al. Comprehensive flexible ureteroscopy (FURS) simulator for training in endourology: the K-box model. Cent Eur J Urol 2016; 69:118-20.
|
[16] |
Hammond L, Ketchum J, Schwartz BF. A new approach to urology training: a laboratory model for percutaneous nephrolithotomy. J Urol 2004; 172:1950-2.
doi: 10.1097/01.ju.0000140279.15186.20
pmid: 15540763
|
[17] |
Brunckhorst O, Aydin A, Abboudi H, Sahai A, Khan MS, Dasgupta P, et al. Simulation-based ureteroscopy training: a systematic review. J Surg Educ 2015; 72:135-43.
doi: 10.1016/j.jsurg.2014.07.003
pmid: 25130385
|
[18] |
Farcas M, Reynolds LF, Lee JY. Simulation-based percutaneous renal access training: evaluating a novel 3D immersive virtual reality platform. J Endourol 2021; 35:695-9.
doi: 10.1089/end.2020.0674
pmid: 33261507
|
[19] |
Brehmer M, Swartz R. Training on bench models improves dexterity in ureteroscopy. Eur Urol 2005; 48:458-63.
pmid: 15964129
|
[20] |
Khan MS, Ahmed K, Gavazzi A, Gohil R, Thomas L, Poulsen J, et al. Development and implementation of centralized simulation training: evaluation of feasibility, acceptability and construct validity. BJU Int 2013; 111:518-23.
doi: 10.1111/j.1464-410X.2012.11204.x
pmid: 22928639
|
[21] |
Kozan AA, Chan LH, Biyani CS. Current status of simulation training in urology: a non-systematic review. Res Rep Urol 2020; 12:111-28.
doi: 10.2147/RRU.S237808
pmid: 32232016
|
[22] |
Knoll T, Trojan L, Haecker A, Alken P, Michel MS. Validation of computer-based training in ureterorenoscopy. BJU Int 2005; 95:1276-9.
pmid: 15892816
|
[23] |
Aloosh M, Noureldin YA, Andonian S. Transfer of flexible ureteroscopic stone-extraction skill from a virtual reality simulator to the operating theatre: a pilot study. J Endourol 2016; 30:1120-5.
pmid: 27532227
|
[24] |
Bissonnette V, Mirchi N, Ledwos N, Alsidieri G, Winkler-Schwartz A, Del Maestro RF. Artificial intelligence distinguishes surgical training levels in a virtual reality spinal task. J Bone Joint Surg Am 2019; 101:127. https://doi.org/10.2106/JBJS.18.01197.
doi: 10.2106/JBJS.18.01197
pmid: 31800431
|
[25] |
Mirchi N, Bissonnette V, Yilmaz R, Ledwos N, Winkler-Schwartz A, Del Maestro RF. The virtual operative assistant: an explainable artificial intelligence tool for simulation-based training in surgery and medicine. PLoS One 2020; 15:1-15.
|
[26] |
Chou DS, Abdelshehid C, Clayman RV, McDougall EM. Comparison of results of virtual-reality simulator and training model for basic ureteroscopy training. J Endourol 2006; 20: 266-71.
pmid: 16646655
|
[27] |
Mishra S, Kurien A, Ganpule A, Muthu V, Sabnis R, Desai M. Percutaneous renal access training: content validation comparison between a live porcine and a virtual reality (VR) simulation model. BJU Int 2010; 106:1753-6.
doi: 10.1111/j.1464-410X.2010.09753.x
pmid: 20950308
|
[28] |
Pallavicini F, Pepe A, Clerici M, Mantovani F. Virtual reality applications in medicine during the COVID-19 pandemic: systematic review. JMIR Serious Games 2022; 10:e35000. https://doi.org/10.2196/35000.
doi: 10.2196/35000
|
[29] |
Overtoom EM, Horeman T, Jansen FW, Dankelman J, Schreuder HWR. Haptic feedback, force feedback, and forcesensing in simulation training for laparoscopy: a systematic overview. J Surg Educ 2019; 76:242-61.
doi: S1931-7204(18)30039-4
pmid: 30082239
|
[30] |
Durutovi? O, Filipovi? A, Mili?evi? K, Somani B, Emiliani E, Skolarikos A, et al. 3D imaging segmentation and 3D rendering process for a precise puncture strategy during PCNLda pilot study. Front Surg 2022;9:1-7.
|
[31] |
Negassi M, Suarez-Ibarrola R, Hein S, Miernik A, Reiterer A. Application of artificial neural networks for automated analysis of cystoscopic images: a review of the current status and future prospects. World J Urol 2020; 38:2349-58.
doi: 10.1007/s00345-019-03059-0
pmid: 31925551
|
[32] |
Hameed BMZ, Somani S, Keller EX, Balamanigandan R, Mahapatra S, Pietropaolo A, et al. Application of virtual reality, augmented reality, and mixed reality in endourology and urolithiasis: an update by YAU Endourology and Urolithiasis Working Group. Front Surg 2022; 9:362. https://doi.org/10.3389/FSURG.2022.866946/BIBTEX.
|
[33] |
Somani BK, Van Cleynenbreugel B, Gozen A, Palou J, Barmoshe S, Biyani S, et al. The European urology residents education programme hands-on training format: 4 years of hands-on training improvements from the European School of Urology. Eur Urol Focus 2019; 5:1152-6.
doi: S2405-4569(18)30080-4
pmid: 29550077
|
[34] |
Schilling D, Gakis G, Walcher U, Stenzl A, Nagele U. The learning curve in minimally invasive percutaneous nephrolitholapaxy: a 1-year retrospective evaluation of anovice and an expert. World J Urol 2010 296 2010;29:749-53.
|
[35] |
de la Rosette JJMCH, Laguna MP, Rassweiler JJ, Conort P. Training in percutaneous nephrolithotomyda critical review. Eur Urol 2008; 54:994-1003.
doi: 10.1016/j.eururo.2008.03.052
pmid: 18394783
|
[36] |
Quirke K, Ayd A, Bultitude M, Sar K, Glass J, Khan A, et al. Development and content validation of the percutaneous nephrolithotomy assessment score. Int J Urol 2020; 27:960-4.
doi: 10.1111/iju.v27.11
|
[37] |
Brinkman WM, Tjiam IM, Schout BMA, Muijtjens AMM, Van Cleynenbreugel B, Koldewijn EL, et al. Results of the European basic laparoscopic urological skills examination. Eur Urol 2014; 65:490-6.
doi: 10.1016/j.eururo.2013.10.036
pmid: 24231256
|
[38] |
Veneziano D, Ploumidis A, Proietti S, Tokas T, Kamphuis G, Tripepi G, et al. Validation of the endoscopic stone treatment step 1 (EST-s1): a novel EAU training and assessment tool for basic endoscopic stone treatment skillsda collaborative work by ESU, ESUT and EULIS. World J Urol 2019;38: 193-205.
|
[39] |
Jones P, Pietropaolo A, Chew BH, Somani BK. Atlas of scoring systems, grading tools, and nomograms in endourology: a comprehensive overview from the TOWER Endourological Society Research Group. J Endourol 2021; 35:1863-82.
doi: 10.1089/end.2021.0124
|
[40] |
Antoniou V, Pietropaolo A, Somani BK. Lithotripsy devices for percutaneous nephrolithotomy (PNL)dnew developments. Curr Opin Urol 2022; 32:405-10.
doi: 10.1097/MOU.0000000000000996
pmid: 35674683
|
[41] |
Pietropaolo A, Jones P, Whitehurst L, Somani BK. Role of "dusting and pop-dusting" using a high-powered (100 W) laser machine in the treatment of large stones (≥15 mm): prospective outcomes over 16 months. Urolithiasis 2019;47: 391-4.
|
[42] |
Wright AE, Rukin NJ, Somani BK. Ureteroscopy and stones: current status and future expectations. World J Nephrol 2014; 3:243. https://doi.org/10.5527/WJN.V3.I4.243.
doi: 10.5527/wjn.v3.i4.243
|
[43] |
Glassman D, Yiasemidou M, Ishii H, Somani BK, Ahmed K, Biyani CS. Effect of playing video games on laparoscopic skills performance: a systematic review. J Endourol 2016; 30. https://doi.org/10.1089/end.2015.0425.
|
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[2] |
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[5] |
Rajiv N. Kore. Management of urethral strictures and stenosis caused by the endo-urological treatment of benign prostatic hyperplasia—a single-center experience[J]. Asian Journal of Urology, 2023, 10(2): 137-143. |
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[7] |
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[9] |
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[13] |
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[14] |
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[15] |
Yinghao Sun,Liqun Zhou,Junhua Zhang,Nianzeng Xing,Qian Zhang,Xiuzhong Hu,Linhui Wang,Yinglu Guo. Census report on Chinese urological surgeons[J]. Asian Journal of Urology, 2020, 7(2): 149-160. |
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