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Simulation in Urology Residency: Teaching Technique, Clinical Reasoning and Medical Knowledge in Urinary Incontinence
Simone Thavaseelan, MD, Rashmi Licht, MD, Janice Santos, MD.
Brown University, Providence, RI, USA.

Background:
We identified lower than expected performance by urology residents in urologic incontinence on standardized national in-service examinations and devised an intervention to improve their knowledge through surgical simulation. Surgical simulation as an education intervention has been used to improve trainee performance of technical skills while didactic lecture focus on core knowledge. We used a highly structured and faculty-facilitated session of didactic lecture, hands on simulation and problem base learning to improve resident technique, clinical reasoning and medical knowledge in the field of urinary incontinence management. We hypothesized that surgical simulation training as an educational intervention would improve urology resident’s clinical reasoning and medical knowledge and technical skills in urinary incontinence as assessed by a pre and post intervention assessment and direct observation.
Methods
We devised a 3.5 hour educational intervention consisting of a 20 minute pre intervention multiple choice assessment test; a 60 minute didactic lecture on clinical diagnosis of incontinence, overactive bladder and stress urinary incontinence; 2 hours of rotating surgical simulation sessions guided by facilitators with paired trainees attending hands on stations in urethral sling placement, sacral nerve stimulator placement, intravesical botox injection, intraurethral bulking agent injection and urodynamics interpretation; followed by a 20 minute post intervention multiple choice assessment test. 6 facilitators guided 8 trainees thru the training in September 2016. Endpoints assessed were pre and post intervention assessment examination aggregate resident scores, pre (2016) and post (2017) intervention American Urologic Association In-service Examination results, direct observation of trainee performance by facilitator, and trainee evaluations of the educational intervention.
Results
Pre and post intervention aggregate assessment scores (n=8) were 49.8% and 78.5% respectively, demonstrating a 31.3% improvement in short term core knowledge acquisition. Pre and post intervention aggregate American Urologic Association in-service examination in the subcategory of neurogenic bladder, voiding dysfunction, incontinence were 64% and 66% respectively. Trainee evaluations showed 75% rated the objectives, instruction, facilities and design of the curriculum to be excellent.
Conclusions
Surgical Simulation as an educational intervention to improve medical knowledge and technical skills in urinary incontinence was successful. Short term medical knowledge assessments improved significantly with the training and trainees had a very favorable evaluation of the multiple educational methods that included didactic lecture, hands on simulation and problem base learning. Long term retention of knowledge was harder to demonstrate. Future directions include expanding this format to other areas of urologic training, further developing the competency of the faculty facilitators and refining the assessment tools to measure improvement in trainee’s competencies.


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