Objective Assessment and Standard Setting for Basic Flexible Ureterorenoscopy Skills Among Urology Trainees Using Simulation-Based Methods.

Objective: To objectively assess the performance of graduating urology residents performing flexible ureterorenoscopy (fURS) using a simulation-based model and to set an entrustability standard or benchmark for use across the educational spectrum. Methods: Chief urology residents and attending endourologists performed a standardized fURS task (ureterorenoscopy and repositioning of stones) using a Boston Scientific© Lithovue ureteroscope on a Cook Medical© URS model. All performances were video-recorded and blindly scored by both endourology experts and crowd-workers (C-SATS) using the Ureteroscopic Global Rating Scale, plus an overall entrustability score. Validity evidence supporting the scores was collected and categorized. The Borderline Group (BG) method was used to set absolute performance standards for the expert and crowdsourced ratings. Results: A total of 44 participants (40 chief residents, 4 faculties) completed testing. Eighty-three percent of participants had performed >50 fURS cases at the time of the study. Only 47.7% (mean score 12.6/20) and 61.4% (mean score 12.4/20) of participants were deemed "entrustable" by experts and crowd-workers, respectively. The BG method produced entrustability benchmarks of 11.8/20 for experts and 11.4/20 for crowd-worker ratings, resulting in pass rates of 56.9% and 61.4%. Conclusion: Using absolute standard setting methods, benchmark scores were set to identify trainees who could safely carry out fURS in the simulated setting. Only 60% of residents in our cohort were rated as entrustable. These findings support the use of benchmarks to earlier identify trainees requiring remediation.

The Canadian StoneBreaker trial: a randomized, multicenter trial comparing the LMA StoneBreaker™ and the Swiss LithoClast® during percutaneous nephrolithotripsy.

BACKGROUND AND PURPOSE: Percutaneous nephrolithotripsy (PCNL) is the treatment of choice for patients with large renal stones. The StoneBreaker™ (SB) is a novel handheld pneumatic lithotriptor, powered by a compressed carbon dioxide cartridge. The purpose of this study was to compare the efficiency of the SB to a standard pneumatic lithotriptor, the Swiss LithoClast(®) (LC). PATIENTS AND METHODS: From January 2008 to December 2009, patients undergoing PCNL were randomized to either the SB or the Swiss LC. Primary outcomes included time to fragment the stone, retrieve the fragments, and remove debris using ultrasonic lithotripsy. Secondary end points were stone-free rate, lithotriptor setup time, ease of use, operator fatigue, endoscopic visualization, damage to mucosa, and device-related complications. RESULTS: Of the initial 115 patients recruited, 77 were enrolled and 38 were excluded. The SB had significantly faster stone fragmentation time, total lithotripsy time, and setup time than the Swiss LC (P ≤ 0.05). A significant difference was also noted in the ease of use and operator fatigue in favor of the SB. There were no device-related complications. CONCLUSION: The SB pneumatic lithotriptor is easier to set up and use, and it provides faster stone fragmentation than the Swiss LC.