Training Implications for Stone Management

The potential to learn in the operating room is becoming increasingly limited by factors such as resident work hour restrictions, the increased cost associated with trainee involvement in the operating room, the demands on clinicians to increase productivity, the increased complexity of patient diagnoses seen in tertiary care medical centers, and the overall goal to decrease patient morbidity and mortality. Surgical educators are seeking alternative methods of training and developing simulated teaching environments in an effort to address these educational challenges. Endourology poses unique challenges, with steep learning curves for the surgeon, as it creates a visual image of the operative site that has altered depth perception, decreased tactile feedback, increased dependence on video monitors, and increased demand on hand–eye coordination. The importance of creating standardized curricula for training programs is becoming increasingly important for minimally invasive technologies. Curriculum designed for technical skill education involves setting goals and objectives at the commencement, designing interventions targeted to these goals, and developing assessment tools that can certify competency in the desired skills. A variety of teaching strategies have been utilized in the development of curricula for endourology including material-based models, animate and cadaveric models, and virtual reality simulation. All of these have their advantages and disadvantages and in combination provide a robust and comprehensive skills training platform to complement the cognitive training that is required for mastering endourologic concepts and techniques. With computer-based surgical simulation, a trainee may be truly evaluated objectively in the absence of bias for race, sex, or age. The integration of simulation into the surgical training curriculum will allow the trainee to acquire the basic surgical skills foundation and obtain performance levels according to predetermined proficiency levels for each stage of the training program. This then allows the surgical educator to concentrate on teaching the judgment and professionalism of an expert surgeon, and to strengthen the knowledge and interpretation of what is observed in the clinical setting in order to create a competent surgeon at both the cognitive and skills performance levels.