- Email: [email protected]
Editorial Comment on: Assessment of Laparoscopic Suturing Skills of Urology Residents: A Pan-European Study
EUROPEAN UROLOGY 56 (2009) 865–873
873
surgery in endoscopic extraperitoneal radical prostatectomy. Eur
residency training programs: an assessment by program direc-
Urol 2006;49:491–500.
tors. J Urol 2007;177:288–91.
[4] Laguna MP, Schreuders LC, Rassweiler JJ, et al. Development of laparoscopic surgery and training facilities in Europe: results of a survey of the European Society of Uro-Technology (ESUT). Eur Urol 2005;47:346–51.
DOI: 10.1016/j.eururo.2008.09.046
[5] Le CQ, Lightner DJ, VanderLei L, Segura JW, Gettman MT. The current role of medical simulation in American urological
Editorial Comment on: Assessment of Laparoscopic Suturing Skills of Urology Residents: A Pan-European Study Antonio Galfano Department of Surgical and Oncological Sciences, Urology Clinic – University of Padua, via Giustiniani, 2, 35100 Padova, Italy [email protected] The European Urological Residents Education Programme (EUREP) is a noteworthy occasion of learning for European residents, with the top experts in virtually all urologic fields available as teachers. The introduction of the hands-on training programme provided a further improvement in the usefulness of this event, giving a practical cut to the course, although with a lab model. The authors of this study [1] should be applauded for the idea of further transforming this educational event into an occasion for evaluating the practical skills provided by European urology schools to residents. Different training models have already been proposed for teaching endoscopic, endourologic [2], and laparoscopic skills, but no standardised global consensus has yet been reached concerning optimised outcomes to be achieved during laparoscopic training [3]. Considering the timely and fashionable widespread attraction exerted by laparoscopy in urology, it is not surprising that 96% of residents are interested in training on a laparoscopic simulator. In contrast, it is disappointing that only 41% of them had had the opportunity to use a laparoscopic simulator during the course of residency [1]. Moreover, most of the residents reported having few or insufficient skills in laparoscopic models, even in the final years of residency. This admission shows that, too often, residents’ programmes suffer from a limited use of constantly updated surgical programmes. A possible explanation for this problem might be limited economic
DOI of original article: 10.1016/j.eururo.2008.09.045
resources, especially in developing countries. Nevertheless, low-cost alternative lab models can be used with good results in terms of skills improvement [4]. One last point is the real transferability of the technical skills acquired through a lab model to the surgical patient. Even though transfer validity from lab models to the operating room has already been demonstrated [5], virtual training must be considered only the first step of a surgical learning curve that should begin as soon as possible during the residency year, before learning skills, visual memory, and psychomotor performances drop down [6].
References [1] Kroeze SGC, Mayer EK, Chopra S, Aggarwal R, Darzi A, Patel A. Assessment of laparoscopic suturing skills of urology residents: a pan-European study. Eur Urol 2009;56:865–73. [2] Schout BMA, Hendrikx AJM, Scherpbier AJJA, Bemelmans BLH. Update on training models in endourology: a qualitative systematic review of the literature between January 1980 and April 2008. Eur Urol 2008;54:1247–61. [3] Kommu SS, Dickinson AJ, Rane´ A. Optimizing outcomes in laparoscopic urologic training: toward a standardized global consensus. J Endourol 2007;21:378–85. [4] Chandrasekera SK, Donohue JF, Orley D, et al. Basic laparoscopic surgical training: examination of a low-cost alternative. Eur Urol 2006;50:1285–91. [5] Sugiono M, Teber D, Anghel G, et al. Assessing the predictive validity and efficacy of a multimodal training programme for laparoscopic radical prostatectomy (LRP). Eur Urol 2007;51:1332–40. [6] Boom-Saad Z, Langenecker SA, Bieliauskas LA, et al. Surgeons outperform normative controls on neuropsychologic tests, but age-related decay of skills persists. Am J Surg 2008;195:205–9.
DOI: 10.1016/j.eururo.2008.09.047 DOI of original article: 10.1016/j.eururo.2008.09.045
873
surgery in endoscopic extraperitoneal radical prostatectomy. Eur
residency training programs: an assessment by program direc-
Urol 2006;49:491–500.
tors. J Urol 2007;177:288–91.
[4] Laguna MP, Schreuders LC, Rassweiler JJ, et al. Development of laparoscopic surgery and training facilities in Europe: results of a survey of the European Society of Uro-Technology (ESUT). Eur Urol 2005;47:346–51.
DOI: 10.1016/j.eururo.2008.09.046
[5] Le CQ, Lightner DJ, VanderLei L, Segura JW, Gettman MT. The current role of medical simulation in American urological
Editorial Comment on: Assessment of Laparoscopic Suturing Skills of Urology Residents: A Pan-European Study Antonio Galfano Department of Surgical and Oncological Sciences, Urology Clinic – University of Padua, via Giustiniani, 2, 35100 Padova, Italy [email protected] The European Urological Residents Education Programme (EUREP) is a noteworthy occasion of learning for European residents, with the top experts in virtually all urologic fields available as teachers. The introduction of the hands-on training programme provided a further improvement in the usefulness of this event, giving a practical cut to the course, although with a lab model. The authors of this study [1] should be applauded for the idea of further transforming this educational event into an occasion for evaluating the practical skills provided by European urology schools to residents. Different training models have already been proposed for teaching endoscopic, endourologic [2], and laparoscopic skills, but no standardised global consensus has yet been reached concerning optimised outcomes to be achieved during laparoscopic training [3]. Considering the timely and fashionable widespread attraction exerted by laparoscopy in urology, it is not surprising that 96% of residents are interested in training on a laparoscopic simulator. In contrast, it is disappointing that only 41% of them had had the opportunity to use a laparoscopic simulator during the course of residency [1]. Moreover, most of the residents reported having few or insufficient skills in laparoscopic models, even in the final years of residency. This admission shows that, too often, residents’ programmes suffer from a limited use of constantly updated surgical programmes. A possible explanation for this problem might be limited economic
DOI of original article: 10.1016/j.eururo.2008.09.045
resources, especially in developing countries. Nevertheless, low-cost alternative lab models can be used with good results in terms of skills improvement [4]. One last point is the real transferability of the technical skills acquired through a lab model to the surgical patient. Even though transfer validity from lab models to the operating room has already been demonstrated [5], virtual training must be considered only the first step of a surgical learning curve that should begin as soon as possible during the residency year, before learning skills, visual memory, and psychomotor performances drop down [6].
References [1] Kroeze SGC, Mayer EK, Chopra S, Aggarwal R, Darzi A, Patel A. Assessment of laparoscopic suturing skills of urology residents: a pan-European study. Eur Urol 2009;56:865–73. [2] Schout BMA, Hendrikx AJM, Scherpbier AJJA, Bemelmans BLH. Update on training models in endourology: a qualitative systematic review of the literature between January 1980 and April 2008. Eur Urol 2008;54:1247–61. [3] Kommu SS, Dickinson AJ, Rane´ A. Optimizing outcomes in laparoscopic urologic training: toward a standardized global consensus. J Endourol 2007;21:378–85. [4] Chandrasekera SK, Donohue JF, Orley D, et al. Basic laparoscopic surgical training: examination of a low-cost alternative. Eur Urol 2006;50:1285–91. [5] Sugiono M, Teber D, Anghel G, et al. Assessing the predictive validity and efficacy of a multimodal training programme for laparoscopic radical prostatectomy (LRP). Eur Urol 2007;51:1332–40. [6] Boom-Saad Z, Langenecker SA, Bieliauskas LA, et al. Surgeons outperform normative controls on neuropsychologic tests, but age-related decay of skills persists. Am J Surg 2008;195:205–9.
DOI: 10.1016/j.eururo.2008.09.047 DOI of original article: 10.1016/j.eururo.2008.09.045