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New England Section of the American Urological Association

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Virtual learning with remote proctoring for inflatable penile prosthesis (IPP) training: a feasibility study for socially distanced education
Ahmed Ghazi, MD1, Michael W. Witthaus, MD1, Molly E. Reissmann, MD2, Patrick Saba, BA3, Rachel Melnyk, BS, MS3, Ricardo Munarriz, MD2.
1University of Rochester Medical Center, Rochester, NY, USA, 2Boston University Medical Center, Boston, MA, USA, 3Simulation Innovation Laboratory, University of Rochester, Rochester, NY, USA.

Background: COVID-19 has changed the educational landscape precluding in-person surgical training opportunities. Our objective is to examine the utility and feasibility of remote proctoring for IPP surgical skills training using a validated full-procedural hydrogel simulation model.
Methods: Nine urology residents at the University of Rochester (PGY 1-4) were paired and remotely proctored by an expert at Boston University using the Zoom web conferencing tool. During IPP training sessions, both participants and proctor were given a model with a full surgical setup. Pre-learning included a narrated full-procedural demonstration by the proctor followed by a full procedure IPP simulation guided by proctor feedback. Pre- and post-training surveys assessed confidence (0-100) and procedural knowledge (15 questions). Opinions on virtual learning and its application to this training session were collected.
Results: 66.7% of residents never performed a live IPP placement, while the remaining completed a median (IQR) of 6 cases (4.5-8). All confidence and knowledge measures significantly increased after the remote session (Table 1). Knowledge assessment scores increased by 13% following the remote session, which was reflected in an increase in participantsí confidence in the ability to perform a simulated IPP procedure, knowledge of IPP procedural steps, and applied anatomy by 48%, 22%, and 18%, respectively. Despite 77.8% (7/9) of residents having no prior experience with hands-on virtual training, 100% found remote training valuable and beneficial for learning basic IPP skills and steps of the procedure. The residents highly rated the ability to practice complex skills with zero-patient harm (88.9%), the non-biohazardous nature of the model (66.7%), and having their own hydrogel training model (88.9%). 66.7% preferred a hybrid (virtual combined with in-person learning) for future sessions. The limitations include single session, lower quality communication, and lack of an interface for physical guidance within the virtual environment.
Table 1: Confidence and knowledge measures pre-training versus post-training.

Pre-TrainingMedian [IQR]Post-TrainingMedian [IQR]Change (Δ)Median [IQR]p-value
Confidence in Knowledge of Applied Anatomy50[30-65]68[62-72]+18[12-31]0.005
Confidence in Knowledge of IPP Procedural Steps35[23-61]57[47-75]+22[9-27]0.052
Confidence in Ability to Perform a Simulated IPP26[15-60]74[60-82]+48[22-46]<.001
Confidence in Ability to Perform a Live IPP23[11-35]59[41-65]+36[18-39]0.001
Knowledge Assessment %67 [63-78]80[75-92]+13[7-18]0.045

Conclusions: Remote proctoring using a web conferencing tool and non-biohazardous IPP simulation model is feasible with improvement in both confidence and procedural knowledge. Despite its limitations, this approach provides essential opportunities for hands-on training with remote experts in a safe environment during the cessation of in-person training events.

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