Analysis of pitfalls encountered by residents in transurethral procedures in master-apprentice type of training.
OBJECTIVE
Today's simulators are frequently limited in their possibilities to train all aspects of endourological procedures. It is therefore indicated to first make an inventory of training needs before (re)developing simulators. This study examined pitfalls encountered by residents in real-time transurethral procedures.


METHODS
First, difficulties that residents encounter in transurethral procedures (transurethral resection of the bladder tumor [TURBT], transurethral resection of the prostate [TURP], ureterorenoscopy [URS]) were identified by asking urologists and residents to complete an open questionnaire. Based on their answers a list of pitfalls was designed and tested in 28 pilot observations. Then, two raters (interrater agreement 0.72, 0.70, and 0.75 for TURBT, TURP, and URS, respectively) categorized all observed procedure-related interactions between residents and supervisors in 80 procedures as (1) (type of ) pitfall or (2) no pitfall.


RESULTS
Pitfalls most frequently encountered were as follows: (1) planning/anticipation on new situations (median 27.3%, 29.3%, and 31.8% of total pitfalls in TURBT, TURP, and URS, respectively); (2) handling of instruments (11.5%, 10.6%, and 20.0% for TURBT, TURP, and URS); (3) irrigation management for TURBT (7.7%), depth of resection for TURP (8.9%), and use of X-ray for URS (13.3%).


CONCLUSIONS
Designers of endourological simulators should include possibilities to train planning/anticipation on new situations, handling of instruments in all transurethral procedures, and irrigation management in TURBT, depth of resection in TURP, and timing usage of X-ray in URS.
Department of Urology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands. barbara.schout@cze.nl
Barbara M A
BM
Schout
Marjolein C
MC
Persoon
Elisabeth J
EJ
Martens
Bart L H
BL
Bemelmans
Albert J J A
AJ
Scherpbier
Ad J M
AJ
Hendrikx
D000328:Adult; D003710:Demography; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D011795:Surveys and Questionnaires; D013997:Time Factors; D020728:Transurethral Resection of Prostate; D014521:Urethra / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000193:education*