This pilot study shows that that the use of PFHCs in urologic training can be very beneficial in increasing residents’ confidence in performing a variety of urologic procedures, both open and endoscopic. Residents of all levels reported an increased score in all procedures performed. It also demonstrates that the skills and confidence gained in these sessions were at least partially retained, as scores 6 months after the session remained higher than scores prior to the session. It was noted that some scores at 6 months were higher than they were immediately following the session. This was likely due to more exposure to these procedures in the operating room within the first 6 months of completing the session. With the introduction of laparoscopy, robotics, and new minimally invasive endourologic procedures, urology residents must learn a very broad skillset during their training. Simulations such as this provide residents with extra opportunities to learn and improve their skillset in a low stress environment. Residents that participated believed the session accurately simulated the conditions of live surgery, promoted the acquisition of surgical skills, and increased their confidence of handling future intra-operative consults. Furthermore, they felt that this simulation offered benefits not available in existing training models and would recommend this training model to their colleagues.
One major advantage of PFHC over 3D printing is having the ability to operate on human tissue versus synthetic material. Many educators believe that there is truly no substitute for human tissue when learning surgical techniques . 3D printing also requires highly trained computer scientists/engineers who are experts in 3D-printing. These personnel are not widely available, making it difficult for widespread implementation as there are significant barriers when starting a program as well as for maintenance of machines/software. In addition, there are significant costs to consider with 3D-printing based surgical simulation as some printers can cost > $250,000 (http://www.aniwaa.com/).
In 2012, Lewis et al. reported their experience utilizing fresh frozen cadavers to teach anatomy and operative skills to their general surgery residents . Residents indicated that sessions with the cadavers were useful for learning anatomy, learning the steps of various operations, and improved their confidence in doing an operation on their own. Furthermore, the vast majority of residents expressed interest in participating in additional sessions and stated they would spend their free time in the cadaver laboratory if allowed to do so. Our study varied as we utilized fresh cadavers that never underwent a freeze/thaw cycle. In addition, junior residents were able to participate in all procedures in our simulation, even those deemed to be above their training level such as complex open procedures.
The addition of vascular perfusion further improves the validity of cadaver sessions. By using a red, non-toxic water-based paint, trainees are able to visualize bleeding in real-time during a simulated operation. Carey et al. demonstrated that mean arterial pressures of 80 mm Hg could be established, resulting in microvascular perfusion . This allows for a life-like simulation for residents; bleeding will be encountered, as it would in a real surgical scenario. This type of experience is invaluable when learning how to perform minimally invasive procedures such as TURP as bleeding is one the most common complication of this procedure . Encountering intraoperative bleeding on a cadaver allows residents to experience real-life complications without jeopardizing patient safety. Perfused cadavers have also been used to simulate traumatic injuries in the realm of trauma surgery. In one study, fully trained trauma surgeons participated in a session with perfused cadavers in which various injuries were simulated. Surgeons that participated reported that the perfused cadaver model allowed for an accurate simulation of the challenges faced during operative trauma and helped familiarize them with different techniques and skills . While this study was primarily focused on creating a realistic training simulation, our study assessed the impact of PFHC on trainees’ confidence. While having the recreation of a realistic situation is essential, having a positive impact on trainees’ skills and confidence level is equally as important with any surgical simulation. To date, this is the first documentation of utilizing PFHCs in urologic training.
There are limitations to this study. One inherent limitation is our small sample size of 6 residents. With this small of a sample size, meaningful statistical analysis was unable to be performed. Further sessions with a larger number of urology residents need to be organized to evaluate the true impact that PFHCs may have on urologic training. Another potential limitation of this method is cost. Carey et al. reported that the average cost per PFHC was $1262.55 . This may limit some training programs from using this resource depending on their funding.
The objective of this study was to introduce a new method of training to our urology residents and assess its impact on our residents’ confidence. The increase in survey scores and positive reception by our residents after just one session are very promising, and further investigation into the use of PFHCs in urologic training is warranted.
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