ANAHEIM, CA (UroToday.com) - Drs. Elspeth McDougall and Tadashi Matsuda presented a State-of -the-Art lecture "The Current State-of-the-Art in the Use of Simulators" at the Sunday Plenary session of the AUA in Anaheim, May 20, 2007.

Dr. McDougall presented that a model employing specific skills that can be documented is the educational model of the future. This means simulation training for surgeons, especially with regard to minimally invasive techniques. This is particularly relevant in the face of limited resident hours. Simulation is the technique of imitating the behavior of a situation by means of a suitable analogous situation or apparatus. There is a range of low fidelity simulation which requires more mentor oversight compared to high fidelity virtual instructors, which do not. Virtual reality simulators are costly, but provide high reliability training. Errors made during simulation training can then be corrected through repetitive practice in a no-risk environment and to produce optimal outcomes. This will also reduce the need for animal laboratories. During simulation, the mentor can be focused on the learner, as opposed to the patient, which is what happens during training in the operating room. Simulation links cognition and manipulative skill that combined with judgment that create a "master surgeon", she said. "Attentional resources" are maximized in this learning environment, where the focus is on the simulation and is not distracted by a real patient. This concept of learning and repetitive practice exists in other fields such as music and dance.

Cost is a limiting the development of virtual training, but the AUA combined with a company METI, has developed a laparoscopic transperitoneal simulator. The AUA will develop the validation studies while METI develops the simulator technology. The goal will be to have proficiency and competency components as measures of training. The validation studies are essential to the system in order to predict the performance of the surgeon in the OR. It is a system based upon competency. The new dictum will be "see some, practice many, and do one competently"

A colleague from Kansai University, Dr. Matsuda then spoke further about laparoscopic surgical skills training. The Japanese have developed an endoscopic surgical skill qualification system that is used in all surgical specialties and at all institutions. These permit standardization of skills. For example, a urologist has standard requirements that must be met prior to performing lap operations. A videotape of the applicants' surgery is reviewed by 2 judges who must approve the applicants' video operation for certification. A list of judging criteria was reviewed. The pass rate of the video assessment is 64% and the names of certified urologists are made public. The goal is to improve outcomes for patients. Furthermore, they were able to correlate the accuracy of simulation training with video assessments and the certification rates.

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Written by Christopher G. Wood, MD, a Contributing Editor with UroToday.

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