Elsevier

Urology

Volume 79, Issue 4, April 2012, Pages 815-820
Urology

Laparoscopy and Robotics
Program for Laparoscopic Urologic Skills: A Newly Developed and Validated Educational Program

https://doi.org/10.1016/j.urology.2012.01.014Get rights and content

Objective

To develop and evaluate a program for laparoscopic urologic skills (PLUS) to determine the face, content, and construct validation to achieve uniformity and standardization in training residents in urology.

Methods

The PLUS consists of 5 basic laparoscopic tasks. Three tasks were abstracted from the Fundamentals of Laparoscopic Surgery program, and 2 additional tasks were developed under continuous evaluation by expert urologists. Fifty participants were recruited from different hospitals and performed the final PLUS training. They all completed a questionnaire after performance. Three outcome parameters were measured: performance quality, time, and dropped objects. The relationship between laparoscopic experience and the outcome parameters was investigated.

Results

Of the 50 participants, 13 were students, 20 were residents, and 17 were urologists. Double-log linear regression analysis for all 5 tasks showed a significant effect (effect size range 0.53-0.82; P < .0005) for laparoscopic experience on performance time. Substantial correlations were found between experience and quality ratings (log-linear regression effect size 0.37; P = .012) and the number of dropped objects (Spearman correlation effect size 0.49; P < .01). The usefulness of the PLUS model as a training tool for basic laparoscopic skills was rated 4.55 on a scale from 1 (not useful) to 5 (useful) (standard deviation 0.58; range 3-5).

Conclusion

The results of the present study indicated the face, content, and construct validity for the PLUS. The training is considered appropriate for use as a primary training tool for an entry test or as part of a step-wise training program in which basic and procedural laparoscopic skills are integrated.

Section snippets

Development of the PLUS

We submitted the original FLS training program to the judgment of 8 Dutch urologists, all from different hospitals, who are considered experts in the field of urologic laparoscopy, having performed >500 laparoscopic procedures and/or taught (inter)national laparoscopy courses. After watching the theoretical modules on CD-ROM and performing the 5 original tasks on the box trainer, the experts expressed their opinions in a questionnaire considering the usefulness of each task for urologic

Results

A total of 50 participants were included in the study: 13 students from the University of Maastricht, 20 urologic residents from 6 different hospitals, and 17 urologists from 10 different hospitals. The mean score for laparoscopic experience was 0 for students, 31 ± 18 for residents, and 439 ± 480 for urologists. Five participants were excluded from the analysis of construct validity, because they did not complete the whole PLUS. One participant was excluded from the analysis of face validity

Comment

The results of the present study have confirmed the face, content, and construct validity of a newly developed educational program, the PLUS, consisting of 5 basic tasks. Three tasks were abstracted from the FLS and 2 tasks were newly developed to fit the requirements of urology training programs.

Conclusions

In the present study we showed evidence for face, content, and construct validity of PLUS training to learn basic laparoscopic urologic skills. The PLUS shows promise as a primary training tool for a step-wise training method in which different aspects of basic and procedural skills are integrated. Additional studies should investigate the next steps for laparoscopic training. Also, additional research is needed to define the standards of acceptable performance that can be used for assessment

Acknowledgment

To the 8 experts from Erasmus Medical Center, Radboud University Nijmegen Medical Centre, Canisius-Wilhelmina Hospital, Jeroen Bosch Hospital, Scheperhospital, St-Franciscus Gasthuis, St-Jansdal Hospital, and Rijnstate Hospital, who participated in the development of the PLUS trainer; to all the medical students from Maastricht University and the residents in urology and urologists who were willing to participate in this validation study; and to Mereke Gorsira for her editorial assistance, with

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