Modelo de entrenamiento para el manejo precoz del priapismo / A training model to teach early management of priapism

Antecedentes: El priapismo isquémico es una emergencia urológica que requiere atención médica temprana para evitar daños irreversibles en la función eréctil. La aspiración cavernosa es el primer paso en el tratamiento. Actualmente no hay modelos de entrenamiento satisfactorios para desarrollar habilidades en un ambiente controlado. Por lo tanto, hemos desarrollado un novedoso modelo de entrenamiento para enseñar a los alumnos los pasos de la aspiración del pene de una manera segura y representativa.Materiales y métodosHemos desarrollado un modelo de priapismo usando un antiguo simulador para el entrenamiento del cateterismo. La validez del modelo fue evaluada por participantes y urólogos experimentados en un Boot Camp de urología. Todos habían tratado al menos cinco casos reales de priapismo. Las respuestas fueron reportadas usando una Escala Likert de cinco puntos. Los datos se analizaron utilizando IBM SPSS Statistics V25. La correlación intraclase se calculó mediante un «Modelo aleatorio unidireccional».ResultadosOnce urólogos y siete aprendices participaron en la evaluación. La apariencia del modelo fue la característica mejor evaluada del modelo de priapismo. La retroalimentación táctil de la inserción de la aguja para la aspiración también se consideró realista, con un 72,6% informándolo como «bueno» o «muy bueno» y un 85,7% opinó que el modelo era realista para la inserción de la aguja. La correlación intraclase entre los expertos fue de 0,552. La mayoría de los aprendices (83,3%) informó una simulación realista. Todos los evaluadores estuvieron de acuerdo o muy de acuerdo en que el modelo proporcionaba una buena experiencia de simulación que sería útil para la enseñanza. (AU)

Background: Ischaemic priapism is a urological emergency with early treatment required to prevent irreversible loss of erectile function. Corporal aspiration is the first step in management. Currently, there are no satisfactory training models to develop skills in a controlled environment. We have therefore developed a novel training model to teach trainees the steps of penile aspiration in a safe and representative way.Materials and methodsWe have developed a priapism model using an old catheterisation teaching model. Face validity of the model was assessed by participants and experienced urologists teaching on a urology boot camp. All had managed at least 5 cases of actual priapism. Responses were reported using a 5-point Likert Scale. Data were analysed using IBM SPSS Statistics V25. The intra-class correlation was calculated using a «One-way Random model».ResultsEleven urologists and seven trainees participated in the evaluation. The model appearance was reported as the best simulation trait of the priapism model. Tactile feedback from needle insertion for aspiration was also felt to be realistic with 72.6% reporting it as «Good» or «very good» and 85.7% reported the model to be realistic for needle insertion. Intra-class correlation amongst experts was 0.552. Majority of trainees (83.3%) reported a realistic simulation. All evaluators agreed or strongly agreed that the model provided a good simulated experience that would be useful in training. (AU)

A training model to teach early management of priapism. / Modelo de entrenamiento para el manejo precoz del priapismo.

BACKGROUND: Ischaemic priapism is a urological emergency with early treatment required to prevent irreversible loss of erectile function. Corporal aspiration is the first step in management. Currently, there are no satisfactory training models to develop skills in a controlled environment. We have therefore developed a novel training model to teach trainees the steps of penile aspiration in a safe and representative way. MATERIALS AND METHODS: We have developed a priapism model using an old catheterisation teaching model. Face validity of the model was assessed by participants and experienced urologists teaching on a urology boot camp. All had managed at least 5 cases of actual priapism. Responses were reported using a 5-point Likert Scale. Data were analysed using IBM SPSS Statistics V25. The intra-class correlation was calculated using a «One-way Random model¼. RESULTS: Eleven urologists and seven trainees participated in the evaluation. The model appearance was reported as the best simulation trait of the priapism model. Tactile feedback from needle insertion for aspiration was also felt to be realistic with 72.6% reporting it as «Good¼ or «very good¼ and 85.7% reported the model to be realistic for needle insertion. Intra-class correlation amongst experts was 0.552. Majority of trainees (83.3%) reported a realistic simulation. All evaluators agreed or strongly agreed that the model provided a good simulated experience that would be useful in training. CONCLUSION: Our model provides a realistic simulation of corporal aspiration. It can be used repeatedly. Overall, the proposed model appears to be a promising tool for training junior doctors in the initial management of ischaemic priapism.

Boot camp de simulación en urología: perspectiva de los delegados no británicos / Urology simulation boot camp: A perspective from non-UK delegates

ANTECEDENTES: La simulación médica se ha convertido en una parte integral de la formación quirúrgica moderna. Pero a pesar de sus beneficios, todavía no ha sido ampliamente incorporada en la formación de los residentes. El Boot Camp de Simulación en Urología (BCSU) es un curso innovador de cinco días, dirigido a residentes que entran en el programa de formación del Reino Unido. Desde su implementación ha generado un creciente interés por parte de los residentes no británicos. OBJETIVO: Evaluar la experiencia de los residentes no británicos en el BCSU, tanto cuantitativa como cualitativamente, incluyendo un análisis de la evolución de sus habilidades. Diseño, marco y participantes: Este estudio retrospectivo de doble cohorte incluyó a 20 delegados de países no británicos y 76 residentes del Reino Unido que asistieron al BCSU en 2017 y 2018. Los residentes contestaron preguntas tipo test (PTT) antes y después del curso, cuestionarios de experiencia quirúrgica previos al curso y una encuesta sobre la utilidad de los conocimientos adquiridos, 12 meses después del curso. Medición de resultados y análisis estadístico: Las diferencias en las puntuaciones medias de las PTT entre los delegados del Reino Unido y los no británicos, antes y después del curso, fueron evaluadas con una prueba de T independiente. Cada habilidad de procedimientos de urología básica fue evaluada por un experto y calificada de acuerdo con una escala de Likert (1-5). La prueba de Kruskal-Wallis se utilizó para evaluar las diferencias en las puntuaciones entre ambos grupos en las técnicas de endourología. Se utilizó una escala de Likert (1-5) para calificar las respuestas de los participantes a la encuesta realizada 12 meses después del curso. RESULTADOS Y LIMITACIONES: Los alumnos del Reino Unido obtuvieron una puntuación significativamente más alta en las PTT previas al curso; sin embargo, tras la finalización del entrenamiento, no se observó ninguna diferencia significativa. No hubo diferencias entre los grupos en los tiempos de finalización de las e-BLUS (Habilidades básicas en técnicas por laparoscopia en urología), y ambos grupos mejoraron significativamente sus resultados. Una encuesta realizada 12 meses después del curso sobre la utilidad del entrenamiento durante el campamento y la evaluación cualitativa del curso por parte de los delegados extranjeros fue muy positiva. CONCLUSIONES: El BCSU es una experiencia valiosa de aprendizaje que conduce a una mejora de las habilidades técnicas y sociales de los residentes tanto del Reino Unido como de otros países

BACKGROUND: Medical simulation has become an integral part of modern-day surgical training. Despite its benefits, it is still not widely incorporated in the curriculum of trainees. The Urology Boot Camp (USBC) is an innovative 5-day course aimed at trainees entering the UK training scheme. Since its implementation, there's been increasing interest by non-UK trainees. OBJECTIVE: To assess the experiences of non-UK trainees in the USBC, both quantitatively and qualitatively, including skills progression analysis. Design, setting and participants: This double-group cohort retrospective study included 20 delegates from non-UK countries and 76 trainees from UK who attended the USBC in 2017 and 2018. Trainees undertook pre- and post-course MCQs, pre-course operative experience questionnaires and a 12-month post-course survey on the usefulness of the skills acquired. Outcome measurements and statistical analysis: Differences in mean MCQ scores between UK and non-UK delegates at baseline and after the course were assessed by the independent T-test. Each core urology procedural skill was evaluated by an expert and graded according to a Likert scale (1-5). The Kruskal-Wallis test was used to assess the differences in the scores between both groups on endourological techniques. A Likert scale (1-5) was used to grade the participants' answers to the post-course 12-month survey. Results and limitations: Trainees from UK scored significantly higher in the pre-course MCQ assessment, however after completion of the boot camp, no significant difference was noted. There were no differences between the groups at e-BLUS completion times, and both groups significantly improved their results. A 12-month post-course survey on the utility of training during the boot camp and qualitative evaluation of the course by overseas delegates was very positive. CONCLUSIONS: The USBC is a valuable learning experience that leads to improvement of technical and soft skills of UK and non-UK trainees alike

Development and internal validation of clinical prediction models for outcomes of complicated intra-abdominal infection.

BACKGROUND: Complicated intra-abdominal infections (cIAIs) are associated with significant morbidity and mortality. The aim of this study was to describe the clinical characteristics of patients with cIAI in a multicentre study and to develop clinical prediction models (CPMs) to help identify patients at risk of mortality or relapse. METHODS: A multicentre observational study was conducted from August 2016 to February 2017 in the UK. Adult patients diagnosed with cIAI were included. Multivariable logistic regression was performed to develop CPMs for mortality and cIAI relapse. The c-statistic was used to test model discrimination. Model calibration was tested using calibration slopes and calibration in the large (CITL). The CPMs were then presented as point scoring systems and validated further. RESULTS: Overall, 417 patients from 31 surgical centres were included in the analysis. At 90 days after diagnosis, 17.3 per cent had a cIAI relapse and the mortality rate was 11.3 per cent. Predictors in the mortality model were age, cIAI aetiology, presence of a perforated viscus and source control procedure. Predictors of cIAI relapse included the presence of collections, outcome of initial management, and duration of antibiotic treatment. The c-statistic adjusted for model optimism was 0.79 (95 per cent c.i. 0.75 to 0.87) and 0.74 (0.73 to 0.85) for mortality and cIAI relapse CPMs. Adjusted calibration slopes were 0.88 (95 per cent c.i. 0.76 to 0.90) for the mortality model and 0.91 (0.88 to 0.94) for the relapse model; CITL was -0.19 (95 per cent c.i. -0.39 to -0.12) and - 0.01 (- 0.17 to -0.03) respectively. CONCLUSION: Relapse of infection and death after complicated intra-abdominal infections are common. Clinical prediction models were developed to identify patients at increased risk of relapse or death after treatment, these now require external validation.

Urology simulation boot camp: A perspective from non-UK delegates. / Boot camp de simulación en urología: perspectiva de los delegados no británicos.

BACKGROUND: Medical simulation has become an integral part of modern-day surgical training. Despite its benefits, it is still not widely incorporated in the curriculum of trainees. The Urology Boot Camp (USBC) is an innovative 5-day course aimed at trainees entering the UK training scheme. Since its implementation, there's been increasing interest by non-UK trainees. OBJECTIVE: To assess the experiences of non-UK trainees in the USBC, both quantitatively and qualitatively, including skills progression analysis. DESIGN, SETTING AND PARTICIPANTS: This double-group cohort retrospective study included 20 delegates from non-UK countries and 76 trainees from UK who attended the USBC in 2017 and 2018. Trainees undertook pre- and post-course MCQs, pre-course operative experience questionnaires and a 12-month post-course survey on the usefulness of the skills acquired. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Differences in mean MCQ scores between UK and non-UK delegates at baseline and after the course were assessed by the independent T-test. Each core urology procedural skill was evaluated by an expert and graded according to a Likert scale (1-5). The Kruskal-Wallis test was used to assess the differences in the scores between both groups on endourological techniques. A Likert scale (1-5) was used to grade the participants' answers to the post-course 12-month survey. RESULTS AND LIMITATIONS: Trainees from UK scored significantly higher in the pre-course MCQ assessment, however after completion of the boot camp, no significant difference was noted. There were no differences between the groups at e-BLUS completion times, and both groups significantly improved their results. A 12-month post-course survey on the utility of training during the boot camp and qualitative evaluation of the course by overseas delegates was very positive. CONCLUSIONS: The USBC is a valuable learning experience that leads to improvement of technical and soft skills of UK and non-UK trainees alike.

Modelo simple y novedoso para la formación del recambio de catéter suprapúbico (CSP) / A simple novel training model for teaching suprapubic catheter (SPC) exchange

OBJETIVOS: Desarrollar un modelo de formación sobre el catéter suprapúbico (CSP), ya que no existe un modelo realista específico para replicar el recambio de CSP. MATERIALES Y MÉTODOS: Describimos un modelo animal de simulación, anatómicamente realista, para su uso en la formación del manejo del CSP, el cual fue probado por residentes de urología y validado por urólogos expertos. Usando una pared abdominal porcina, se creó una reproducción a escala de la pared abdominal. Un segmento del intestino delgado fue cosido alrededor de un catéter de Foley de tamaño 16F para formar el tubo. Se crea una apertura cilíndrica en la pared abdominal, realizando un canal para introducir el tracto del intestino delgado; este fue suturado en la parte anterior, produciendo una sonda de CSP de apariencia realista. En la parte inferior la sonda fue anastomosada a una vejiga urinaria porcina. La validez de contenido del modelo fue evaluada por 10 urólogos expertos, con una escala de calificación de 8 ítems y 5 puntos, utilizada para evaluar las distintas áreas relevantes del simulador. RESULTADOS: Estas áreas fueron puntuadas de 1 a 5 por 10 urólogos expertos, siendo 1 «totalmente en desacuerdo» y 5 «totalmente de acuerdo». El promedio de la calificación de los expertos fue calculado y tabulado al finalizar la formación. La calificación global del modelo fue de 4,2/5, con un promedio de utilidad para la formación de 4,6/5. CONCLUSIÓN: La respuesta (informal) obtenida por parte de expertos y alumnos fue altamente positiva. En promedio, nuestros expertos reportaron una experiencia satisfactoria con el uso de este simulador como herramienta de formación

OBJECTIVES: To develop a suprapubic catheter (SPC) training model as no specific realistic training model exists to replicate SPC exchange where a catheter tract is present. MATERIALS AND METHODS: We describe a novel, anatomically realistic, animal simulator model for use in SPC training, which was trialed at a national urology simulation boot camp by new urology trainees and validated by expert urologists. A scale reproduction of an abdominal wall was created using a porcine abdominal wall. A segment of small bowel was stitched around a size 16F Foley catheter to form a tract. Abdominal wall tissue was excised cylindrically to create an opening, and the small bowel tract was passed through the abdominal wall and sutured anteriorly, producing a realistic SPC tract: inferiorly, the tract was anastomosed to a porcine urinary bladder. This model was evaluated by 10 expert urologists for content validity with an 8-item 5-point rating scale used to evaluate domains relevant to the simulator. RESULTS: The domains were scored between 1 and 5 by 10 expert urologists, 1 being «strongly disagree» and 5 being «strongly agree». The average expert ratings of the domains were then calculated and tabulated following the training course. There was an average global rating of 4.2/5 for the model, with an average usefulness for training score of 4.6/5. CONCLUSION: The feedback from experts and trainees (informal) was overwhelmingly positive. On average, our experts reported high satisfaction with their experience using this simulator as a training tool

A simple novel training model for teaching suprapubic catheter (SPC) exchange. / Modelo simple y novedoso para la formación del recambio de catéter suprapúbico (CSP).

OBJECTIVES: To develop a suprapubic catheter (SPC) training model as no specific realistic training model exists to replicate SPC exchange where a catheter tract is present. MATERIALS AND METHODS: We describe a novel, anatomically realistic, animal simulator model for use in SPC training, which was trialed at a national urology simulation boot camp by new urology trainees and validated by expert urologists. A scale reproduction of an abdominal wall was created using a porcine abdominal wall. A segment of small bowel was stitched around a size 16F Foley catheter to form a tract. Abdominal wall tissue was excised cylindrically to create an opening, and the small bowel tract was passed through the abdominal wall and sutured anteriorly, producing a realistic SPC tract: inferiorly, the tract was anastomosed to a porcine urinary bladder. This model was evaluated by 10 expert urologists for content validity with an 8-item 5-point rating scale used to evaluate domains relevant to the simulator. RESULTS: The domains were scored between 1 and 5 by 10 expert urologists, 1 being «strongly disagree¼ and 5 being «strongly agree¼. The average expert ratings of the domains were then calculated and tabulated following the training course. There was an average global rating of 4.2/5 for the model, with an average usefulness for training score of 4.6/5. CONCLUSION: The feedback from experts and trainees (informal) was overwhelmingly positive. On average, our experts reported high satisfaction with their experience using this simulator as a training tool.

The Success and Evolution of a Urological "Boot Camp" for Newly Appointed UK Urology Registrars: Incorporating Simulation, Nontechnical Skills and Assessment.

BACKGROUND: Urological training has dramatically changed in recent years. Training durations are shorter and a drive toward consultant led care has reduced trainees experience. Within the UK, approximately 50 registrars annually embark on a 5-year Urology training programme, with variable levels of basic urological experience. OBJECTIVE: To describe a simulation programme aimed at delivering the knowledge and skills necessary to safely and effectively start working as a registrar in Urology by intensive training with a 1:1 faculty to delegate ratio. DESIGN, SETTING, AND PARTICIPANTS: Our course content mirrors the UK training syllabus for junior Urology registrars. We delivered 8 modules over a 4-day programme with a fifth day of assessments. Delegates level of urological knowledge, operative competency and confidence pre-, immediately post-training and at 3-months postcourse were assessed. Objective delegate and faculty feedback was also collected. Technical skills modules include; inguinoscrotal surgery, ureteroscopy, transurethral resection, urodynamics, and Botox administration as well as basic reconstructive and laparoscopic operative skills. "Nontechnical" skills included simulated ward round, out-patient, and emergency scenarios. RESULTS: Feedback from delegates and faculty members has been overwhelmingly positive. We have used this feedback to tailor the content of the course for following years. An increased knowledge level (based on mean examination scores [precourse 55.5%, postcourse 70.1%]) and operative competency was observed in all skills assessed (transurethral resection of the prostate, transurethral resection of bladder tumor, Ureteroscopy, laparoscopic skills, and instrument assembly). Operative confidence was increased immediately and at 3-months postcourse. CONCLUSIONS: Our "boot camp" course provides a realistic introduction and foundation to begin Urological practice. Being delivered at the beginning of the training scheme, prior to intensive patient exposure, registrars are in an optimum position to develop their newly acquired knowledge and skills to enhance training and intends to improve patient safety and satisfaction.