Simulation-based training in urology: A systematic literature review

Background: Simulation-based training is taking an increasingly important place in surgical training and is becoming mandatory with the latest reform of the French medical studies.

Objective: The objectives of this work were to report the various simulation tools available for the surgical training in urology, along with their validation level, through a systematic literature review. A search was conducted using Medline® with the terms "urology" and "simulator". Articles in English and French were selected.

Methods: Two hundred and ninety-one abstracts were read, allowing for the selection of 154 articles read to assess their eligibility. Studies whose main objective was not the validation of a simulator, studies describing animal models or studies whose full text was not available were excluded.

Results: One hundred and six studies were analyzed in this review. The simulators described were classified in 7 categories: laparoscopic surgery, robotic surgery, ureteroscopy, percutaneous nephrolithotomy, endoscopic bladder and prostate surgery, basic skills in urology, and ultrasound-guided prostate interventions simulators. Apparent and content validity were demonstrated for most simulators, but construct and predictive validity were often lacking.

Conclusions: We did not consider the use of simulators as competency evaluation tools. Besides, the latest terminology proposed to define the various validation steps was not taken into account. Conclusions: Many simulators are available in the field of urology and allow the reproduction of a large variety of urological procedures. However, their validation level is inconsistent, and has to be taken into account when choosing a simulator for surgical training, along with its cost, the eagerness of students to use the simulator and its availability.