Ureteroscopy and cystoscopy training: comparison between two generations of transparent simulators

INTRODUCTION AND OBJECTIVES: Simulators have been widely used to train operational skills, how to improve its effectiveness deserves further investigation. In the previous study, a randomized, controlled trial study of training ureteroscopy and cystoscopy was conducted via a self‐developed transparent simulator, the result demonstrated transparent simulators allowed students to achieve higher ureteroscopic and cystoscopic proficiency compare to opaque ones. Based on the study, this paper developed a second‐generation simulator which was more transparent than the first one, and compared their efficiency in improving operational skills training. MATERIALS AND METHODS: 64 first‐year medical students underwent identical theoretical training and a 50‐point examination of theoretical knowledge. The students were randomly assigned to 4 groups, group 1 and 2 respectively received 9‐day and 12‐day operative training with the first‐generation simulator, group 3 and 4 respectively received 9‐day and 12‐day operative training with the second‐generation. Then, the trainees' skills at ureteral stent insertion and removal were evaluated using the Uro‐Scopic Trainer and rated on an Objective Structured Assessment of Technical Skills scale (OSATS). Later, an anonymous survey was conducted to compare the transparency, convenience in operating, accuracy in anatomy and promoting understanding of the two simulators. RESULTS: The scores on the theoretical knowledge test were comparable among the training groups, and all student were able to perform ureteral stent insertion and removal. The mean OSATS scores of group 1, 2, 3 and 4 were 17.52±2.25, 22.23±3.38, 21.37±2.88, 23.77±4.03 points respectively (P = 0.001). Of the 64 students, 98.4% rated the second‐generation simulator was more transparent than the first generation, 93.7% thought they were comparable in the convenience of operating, 98.4% thought they were identical in the accuracy of anatomy, and 96.8% thought the secondgeneration simulator promoted understanding even more in training. CONCLUSION: Increasing the transparency of the simulators improved the effectiveness of ureteroscopic and cystoscopic training and shortened the learning cycle. The second generation simulator were potentially more powerful training tools and merited widespread popularization.