External Validation of a Low Fidelity Dry-Lab Platform to enhance microsurgical techniques for Hypospadias Repair
Fardod O'Kelly, MD MA FFSEM FRCS(Urol)1, Barb Lewis, RN MS2, Dan R. Gralnek, MD2, Kevin W. Eliceiri, MD2, Josiah Wolf, MD2, Walid A. Farhat, MD LLM FRCSC FACS2.
1Beacon Hospital, UCD, RCSI, Dublin, Ireland, 2University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA.
BACKGROUND: Hypospadias repair is an index paediatric urology procedure and as such, skill acquisition using surgical loupes is an integral component of training. The Toronto practice curriculum is a 6-task low fidelity tool that deconstructs all of the individual skill components required when performing surgical procedures using loupes. We recently developed a distal hypospadias model that is amenable for urethral plate dissection and suturing to augment this program. In order to assess the curriculum validity, we examined if the curriculum training improved performance on the hypospadias model. METHODS: Fifteen urologic surgery residents were included in the study population. The residents received a theoretical lecture covering the basic knowledge of loupes surgery, stressing the aspects of tissue handling, instrument handling and knot tying. We selected 3 of the 6 low fidelity skills - (1) Parallel Face Suturing, (2) Scissor Cut, and (3) Rice Transfer to Hole. In addition, the residents used the hypospadias model for urethral plate dissection and suturing. Following this, the residents were randomly divided into two groups, group 1 practiced on the low fidelity curriculum (3 tasks) and then performed dissection of the urethral plate and suturing using the hypospadias model, while group 2 performed the hypospadias procedural task first, followed by the low fidelity exercises. Each resident had 55 minutes to practice (25 minutes for the low fidelity curriculum and 30 minutes for hypospadias model). The final products for both the low (suturing and scissor cut) and intermediate fidelity were then blindly reviewed by three independent attending paediatric urologists and graded on accuracy and an end result using a Likert scale of 1 to 5. RESULTS: 15 candidates across Wisconsin, USA and Dublin, Ireland, completed the blinded study to the evaluators. Those candidates who undertook the pre-hypospadias model skills tasks out-performed those who completed the hypospadias repair first by both time and level of overall task completion (Overall score: 4.4/5 vs. 3.3/5). There was no significant difference between the suturing and cutting tasks as a predictor of overall score. Satisfaction rates were very high with 65% respondents after the platform stating that they would be happy to attempt a hypospadias repair under supervision. 93% respondents found this model to be a very useful platform, with 80% believing that the steps of the operation were adequately duplicated. CONCLUSIONS:
This low fidelity platform curriculum externally validates the findings from the initial Toronto group publications. It improves the surgical skills of both junior and senior trainees using loupes, and satisfaction scores were very high. The next step is to move this into a high-fidelity setting using motion and pressure sensors.
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