Effects of standardized language on remote ultrasound-guided percutaneous nephrolithotomy training: A mixed-methods explorative pilot study.

Background: Remote teaching of procedural skills has demonstrated equivalence in knowledge acquisition compared to in-person teaching. Variations in terminology for probe and needle movements may serve as a barrier in remote training of ultrasound (US)-guided renal access for percutaneous nephrolithotomy (PCNL). This pilot study investigated the utility of standardized terminology in remote training of US-guided renal access for PCNL. Hypothesis: Standardization of verbal terminology to describe US probe and needle movement instruction improves remote teaching of US-guided renal access. Methods: Fifteen urology residents (PGY1-6) were stratified by year and randomized into two groups. We provided participants with images illustrating US probe and needle movements labeled with predetermined standardized terminology for the intervention group and images without labels for the control group. Both groups were asked to perform US-guided renal access on a training mannequin with a remote faculty educator with (intervention) or without (control) use of standardized movement instructions. Quantitative outcomes included number of attempts and time to achieve access. All trainees completed pre- and post-session surveys and participated in focus groups; authors conducted thematic analysis of focus group transcripts. Results: Differences in primary outcomes between groups, including number of attempts and time to achieve access of the renal pole, were not statistically significant. Analysis of focus group interviews revealed that the use of standardized terminology in the setting of remote training can reduce trainee confusion by clarifying ambiguity in educator feedback. Discussion: Use of standardized terminology during remote surgical skills training allows for more effective feedback to trainees.

Stener-like lesion of the medial collateral ligament of the knee.

This report describes the identification and management of a Stener-like lesion of the medial collateral ligament of the knee in a 55-year-old woman. Patient underwent magnetic resonance imaging (MRI) following a skiing injury and was found to have a tear of the distal fibers of the superficial medial collateral ligament (MCL) complex, with displacement of the ligament superficial to the tendons inserting at the pes anserinus. Identification of a Stener-like lesion in the setting of MCL injury aids in selecting appropriate management. Prompt surgical intervention is warranted to achieve anatomic healing and prevent long-term valgus instability, chronic pain, and osteoarthritis.