AUA 2019: Development and Validation of a Simulator-based Test in Transurethral Resection of Bladder Tumors - Establishment Pass/Fail Standards

Chicago, IL ( Within this presentation, Dr. Sarah Bube, MD, Ph.D., extrapolated upon the inherently flawed though highly relied upon concept of “see one, do one, teach one” with relation to the current training tactics regarding transurethral resection of bladder (TURBT) tumors. Notoriously, specific knowledge regarding the proper methodology of successful TURBT is extremely difficult to attain within the OR, and often remains insufficient and lacking as a training modality for urology residents. However, proficiency-based surgical simulation-based training, as proposed in this study, indicates a promising new source of information via which the learning of surgical techniques may occur in an environment devoid of patients and associated complexities.

The goal of this study was to explore the possibility of creating a TURBT proficiency test to first, train residents more efficiently and thoroughly on the proper processes, and two, to develop a barometer of proficiency through which a resident’s depth of knowledge may evaluate in a standardized manner.

In this prospective multicenter study, doctors and residents (n=49) were divided into three groups based on years of experience and the number of procedures conducted in their practice: Novice (11), Intermediates (21) and Experts (17). All associated participants were then asked to perform three Virtual Reality (VR) simulation TURBT procedures of which proficiency metrics including the time taken to complete the procedure, the quality of the procedure and efficiency with which it was conducted, were used to calculate a total simulated score (TSS).


This study established validity evidence for their newly developed VR simulator-based technology to determine a pass/fail guideline system in order to effectively train residents and to eventually begin to standardize training techniques specifically pertaining to TURBT. Dr. Bube suggests that this test may be used for a myriad of applications, including that of accreditation purposes.


Dr. Bube also indicated that a further study, branching from the aforementioned study, is currently underway to extrapolate upon the applicability of this technology to several institutions residents’ and their career evolution as they utilize this technology throughout their training.


Presented by: Sarah Bube, MD, Ph.D., Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Capital Region, Denmark

Written by: Courtney Cottone, (Department of Urology, University of California-Irvine) at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois