Simulators have been widely used to train operational skills in urology, how to improve its effectiveness deserves further investigation. In this paper, we evaluated training using a novel transparent anatomic simulator, an opaque model or no simulator training, with regard to post-training ureteroscopy and cystoscopy proficiency. Methods: Anatomically correct transparent and non-transparent endourological simulators were fabricated. Ten experienced urologists provided a preliminary evaluation of the models as teaching tools. 36 first-year medical students underwent identical theoretical training and a 50-point examination of theoretical knowledge. The students were randomly assigned to receive training with the transparent simulator, the non-transparent simulator or detailed verbal instruction only. 12 days after the training session, the trainees’ skills at ureteral stent insertion and removal were evaluated using the Uro-Scopic Trainer and rated on an Objective Structured Assessment of Technical Skills (OSATS) scale.

The use of simulators in medical education began in the 1960s with devices for training resuscitation, anesthetic and clinical skills. Numerous studies have confirmed that medical students can improve their skills and achieve proficiency through simulation training. Ureteroscopy and cystoscopy are essential for the diagnosis and therapy of urological diseases, and repeated hands-on training and standardized learning are necessary for mastering the skills required. However, due to ethical and fiscal concerns, traditional hands-on training of new practitioners with patients has been supplanted by methods that rely on endourological simulators. Both virtual and physical ureteroscopic and cystoscopic simulators have been created, and their value for training new students in the required surgical skills has been demonstrated. Virtual models include the virtual-reality simulator for ureteroscopy and the virtual reality endourological simulator. However, the popularity of virtual models is limited by their high cost and the lack of haptic feedback for the trainee that is provided by physical simulators and clinical experience.

Current physical simulators are primarily bench models, such as the Uro-Scopic Trainer and the adult ureteroscopy and renoscopy simulator. Despite the relative fidelity of these simulators, novices often report that they cannot successfully relate the computer display to actual conditions encountered during surgery. The disparity between the simulated experience and reality encountered in clinical practice translates into greater risk of surgical error and a longer training period. It seems logical that simulators fabricated from transparent material could help alleviate the shortcomings of the training methods described above. A transparent model could allow trainees to more readily observe and correct their errors during the course of training and selfevaluate their skills. To test this theory, we designed and fabricated both transparent and non-transparent ureteroscopy and cystoscopy simulators between October 1, 2013 and September 30, 2014. The present randomized, controlled trial study investigated the relative viability of these simulators as endourological training tools.

The simulator was designed in accordance with three criteria: its dimensions should conform to human anatomy; it should be composed of transparent materials; and it should be able to satisfy the requirements of typical ureteroscopy and cystoscopy training. Training procedures included guidewire insertion, ureteral stent insertion/ removal and stone extraction.

Journal of Nephrology and Urology is an Open Access peer-reviewed publication that discusses current research and advancements in diagnosis and management of kidney disorders as well as related epidemiology, pathophysiology and molecular genetics.

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Mercy Eleanor
Editorial Assistant
Journal of Nephrology and Urology