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Update in Urology, Endourology • IBJUInt. braz j urol 47 (2) • Mar-Apr 2021 • https://doi.org/10.1590/S1677-5538.IBJU.2021.02.07   copy
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Editorial Comment: Objective Assessment and Standard Setting for Basic Flexible Ureterorenoscopy Skills Among Urology Trainees Using Simulation-Based Methods

Authorship SCIMAGO INSTITUTIONS RANKINGS

Mitchell Goldenberg 1 1 Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada; , Michael Ordon 1 1 Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada; , John R D'A Honey 1 1 Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada; , Sero Andonian 2 2 Division of Urology, McGill University Health Centre, McGill University, Quebec, Canada; , Jason Y Lee 3 3 Division of Urology, Department of Surgery, University Health Network-Toronto General Hospital, University of Toronto, Toronto, Canada

COMMENT

Flexible ureterorenoscopy (fURS) is a frequent procedure in urology practice (11. Astolfi RH, Carrera R, Gattas N, Bertolla R, Sepulveda F, Reggio E, et al. Current scenario of endourological treatment of kidney stones in brazil: results of a national survey. Int Braz J Urol. 2020;46:400-8.). Graduating residents are expected to be competent in the skills necessary to perform fURS.

This study aim was to assess the basic fURS skills of graduating residents using a procedure––specific ureteroscopic global rating scale. Forty urology residents in their final year of residency from eleven programs in Canada were evaluated while performing a standardized task using a fURS model. More than 79% of then reported experience in more than 50 fURS. The task was to inspect the entire collecting system and to relocate two lower caliceal stones to an upper calyx using a tipless basket. Expert surgeons and anonymous people from a web platform (crowd-workers) rated the performances. Before the task, all residents felt they would be competent in fURS. However, only 56.9% of the residents were competent enough to perform fURS based on expert ratings and 61.4% based on crowd-workers ratings. Poor outcomes of surgical procedures may be caused by several reasons but surgeon inability must not be one of them (22. Osther PJS. Risks of flexible ureterorenoscopy: pathophysiology and prevention. Urolithiasis. 2018;46:59-67.).

The COVID-19 pandemic caused an abrupt decrease in surgical volume jeopardizing urology training (33. Carneiro A, Wroclawski ML, Nahar B, Soares A, Cardoso AP, Kim NJ, et al. Impact of the COVID-19 Pandemic on the Urologist's clinical practice in Brazil: a management guideline proposal for low- and middle-income countries during the crisis period. Int Braz J Urol. 2020;46:501-10., 44. Iscaife A, Marchini GS, Srougi V, Torricelli FCM, Danilovic A, Vicentini FC, et al. The urologist's role in the fight of COVID-19 pandemic: mandatory mindset shift on the frontline. Int Braz J Urol. 2020;46:879-82.). Simulators and training models already exist to improve proficiency in most common endoscopic procedures and should be more used now (55. Marroig B, Fortes MA, Pereira-Sampaio M, Sampaio FJ, Favorito LA. Two-part silicone mold. A new tool for flexible ureteroscopy surgical training. Int Braz J Urol. 2016;42:850-1., 66. Aditya I, Kwong JCC, Canil T, Lee JY, Goldenberg MG. Current Educational Interventions for Improving Technical Skills of Urology Trainees in Endourological Procedures: A Systematic Review. J Endourol. 2020;34:723-31.). While every effort should be made to mitigate clinical and surgical losses caused by the pandemic, residents should be evaluated in an individual basis to identify and to fix possible gaps before the end of their professional training.

REFERENCES

  • 1
    Astolfi RH, Carrera R, Gattas N, Bertolla R, Sepulveda F, Reggio E, et al. Current scenario of endourological treatment of kidney stones in brazil: results of a national survey. Int Braz J Urol. 2020;46:400-8.
  • 2
    Osther PJS. Risks of flexible ureterorenoscopy: pathophysiology and prevention. Urolithiasis. 2018;46:59-67.
  • 3
    Carneiro A, Wroclawski ML, Nahar B, Soares A, Cardoso AP, Kim NJ, et al. Impact of the COVID-19 Pandemic on the Urologist's clinical practice in Brazil: a management guideline proposal for low- and middle-income countries during the crisis period. Int Braz J Urol. 2020;46:501-10.
  • 4
    Iscaife A, Marchini GS, Srougi V, Torricelli FCM, Danilovic A, Vicentini FC, et al. The urologist's role in the fight of COVID-19 pandemic: mandatory mindset shift on the frontline. Int Braz J Urol. 2020;46:879-82.
  • 5
    Marroig B, Fortes MA, Pereira-Sampaio M, Sampaio FJ, Favorito LA. Two-part silicone mold. A new tool for flexible ureteroscopy surgical training. Int Braz J Urol. 2016;42:850-1.
  • 6
    Aditya I, Kwong JCC, Canil T, Lee JY, Goldenberg MG. Current Educational Interventions for Improving Technical Skills of Urology Trainees in Endourological Procedures: A Systematic Review. J Endourol. 2020;34:723-31.

Publication Dates

  • Publication in this collection
    05 Feb 2021
  • Date of issue
    Mar-Apr 2021
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