Changing concepts in endourological training – SIMULATE trial
Reviewed by Karthik Rajan

Skill acquisition for endourological procedures is markedly different from traditional open surgical procedures, questioning the applicability of the presently used apprenticeship model. The lack of a universal simulation training curriculum has hampered its adoption into mainstream urological training. This study aims to address this by designing a structured curriculum, for ureterorenoscopy (URS) as the index procedure and validating it with a multicentre trial. Participants will be randomised to either simulation-based training (SBT) or non-simulation-based training with the primary outcome being the number of procedures required to achieve proficiency. A two-round Delphi process was used to formulate the URS SBT curriculum. The first round involved 24 trainees who had URS experience and 23 urolithiasis specialists. The curriculum was finalised by 10 specialist urologists. The SBT curriculum involves a sequence of didactic lectures followed by dry lab models, training in non-technical skills and cadaveric simulation finally. The authors aim to follow a sample of 48 trainees over 25 procedures or 18 months, to assess the primary outcome. SBT has been used extensively in military and aviation industries with good success. In addition to the ethical advantages of avoiding training on patients, this model assumes special significance in the current scenario where training opportunities have been limited for trainees all over the world due to pressures from COVID-19. If successful, it offers the opportunity for a paradigm shift in the curriculum of urological training.

Simulation in Urological Training and Education (SIMULATE): protocol and curriculum development of the first multicentre international randomized controlled trial assessing the transferability of simulation-based surgical training.
Aydin A, Ahmed K, Van Hemelrijck M, et al
BJU INTERNATIONAL
2020;126:202–11.