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Impact of Virtual Reality-Simulated Training on Urology Residents Performance of Transurethral Resection of the Prostate
Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Urology in Östergötland.
Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Urology in Östergötland.
Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
2010 (English)In: Journal of endourology, ISSN 0892-7790, E-ISSN 1557-900X, Vol. 24, no 9, 1521-5128 p.Article in journal (Refereed) Published
Abstract [en]

Background: There are today a number of VR-simulators for practicing the TURP procedure, but few data on the effect of training on surgical performance.

Objective: To test if practicing the TURP procedure in a VR-simulator increases the skills and dexterity of urology residents when performing the procedure on patients. Design, setting and participants Twenty-four urology residents attended a five-day course on diagnosis and treatment of benign prostatic enlargement. Each of the residents did three video-recorded TURP procedures on patients.

Intervention: Between two of the procedures the residents underwent criterion-based practice in a TURP simulator (PelvicVision).

Measurements: The TURP procedure was peroperatively evaluated using objective structured assessment of technical skills (OSATS). The video-recordings of the procedures were analyzed on a minute to minute basis regarding the main action during that minute, if that action was successful, and errors.

Results and Limitations: The participating residents rated patient safety as high, they believed they learned most from the real operations, and they gained knowledge about both the procedure and the instrumentation used. The mean practice time in the simulator was 198 minutes before reaching the criterion level. Comparison of the first and last TURP procedures showed an increase in autonomous operation time and in successful actions and a decrease in hemostasis time without increased blood loss. The proportion of residents believed able to perform a simple TURP procedure increased from 10% to about 75%. OSATSscores and self-evaluations were significantly improved. The scores increased significantly more with than without simulator practice. The patient follow-up showed no increased risks or poorer results regarding micturition.

Conclusions: Practice in a simulator based environment improves the skills and dexterity of urology residents when performing the procedure on patients, without increased risks or poorer results for the patients.

Place, publisher, year, edition, pages
Mary Ann Liebert, Inc. , 2010. Vol. 24, no 9, 1521-5128 p.
Keyword [en]
Prostate, transurethral resection of prostate, computer simulation, education, medical, task performance and analysis
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-54462DOI: 10.1089/end.2009.0667ISI: 000281864700026OAI: oai:DiVA.org:liu-54462DiVA: diva2:304098
Available from: 2010-03-17 Created: 2010-03-17 Last updated: 2017-12-12
In thesis
1. Construction, Validation and Application of a Virtual Reality Simulator for the Training of Transurethral Resection of the Prostate
Open this publication in new window or tab >>Construction, Validation and Application of a Virtual Reality Simulator for the Training of Transurethral Resection of the Prostate
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The fundamental of surgical training is the traditional apprenticeship method introduced by William Halsted which has been used for the last 100 years. It is based on learning in the operating room (OR) where the resident is guided by an experienced surgeon and gradually and methodically exposed to surgery. The continuous development of surgical methods together with the growing awareness of medical errors and ethical considerations have made the Halsted method outdated and there is an obvious need to be able to learn the skills of surgery without risking patient safety. New methods such as laparoscopy and endoscopy demand specific skills and abilities that may not be met by everyone. At the same time, the physical limitations of these new methods have made it possible to construct virtual reality (VR) simulators to practise and learn the skills necessary.

This study is about the construction and evaluation of a VR-simulator for the training of transurethral resection of the prostate (TURP). It also concerns the specific abilities needed to become a good surgeon.

A simulator for training TURP was developed after a face validity study where 17 experienced urologists gave their opinion of the specific content necessary for the training of this procedure. After a content validity study by nine experienced urologists and application of necessary improvements, a group of 11 medical students and nine experienced urologists performed a construct validity test where the urologists showed significantly higher levels of both skill and effectiveness compared to the inexperienced students when performing a simulated TURP procedure. The students showed a positive learning curve, but did not reach the levels of the urologists. The results of the experienced urologists were used as the minimal criterion level when 24 urology residents practised the procedure. Training took place while on a course on benign enlargement of the prostate and its treatment options, with emphasis on the “gold standard” treatment – TURP. During the course they performed three guided and video-taped TURP-procedures each on selected patients. Between two of the procedures they performed criterion-based training in the simulator. This VR-to-OR study showed improvement in operative skills with the same patient outcome as in the normal clinical situation. It also showed that simulator training improved their skills even more. During their time on the course their personality traits (TCI) and cognitive abilities (Rey complex figure and recognition trial, tower of London, WAIS-III) were tested. The results showed that a better learning curve in the OR was associated with a better simulator learning curve and a good visuospatial memory. The associated personality traits were high levels of goal directedness, impulse control, responsibility, anticipation of harmful events and a balanced attachment style.

In conclusion, we have demonstrated that it was technically possible to construct a useful simulator for the training of TURP (PelvicVision®) which may now be considered clinically validated for this purpose. Novice training and performance in the simulator improves the learning curve and predicts the resident’s performance in the OR. The results support the implementation of validated simulation technology in a criterion-based training curriculum for residents. Furthermore, the results showed preliminary data on personality traits and visuospatial abilities that are important for learning a complex surgical procedure.

Place, publisher, year, edition, pages
Linköping University Electronic Press, 2010. 86 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1167
Keyword
Surgical education, simulation, transurethral resection of prostate, psychometric tests, personality, validation, virtual reality, proficiency based training, objective assessment
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-54466 (URN)978-91-7393-444-2 (ISBN)
Public defence
2010-04-30, Berzeliussalen, Hälsouniversitetet, Campus Valla, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2010-03-17 Created: 2010-03-17 Last updated: 2015-11-19Bibliographically approved

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Källström, ReidarHjertberg, HansSvanvik, Joar

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Surgery Faculty of Health SciencesDepartment of Urology in ÖstergötlandDepartment of Surgery in Östergötland
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