title: Impact of virtual reality-simulated training on urology residents' performance of transurethral resection of the prostate.
abstract: OBJECTIVE
  There are virtual reality simulators for practicing the transurethral resection of prostate (TURP) procedure, but only few data on its effect on surgical performance are available. The purpose of this study was to test if practicing the TURP procedure in a virtual reality simulator (PelvicVision) increases the skills and dexterity of urology residents when performing the procedure on patients.
  
  
  METHODS
  Twenty-four urology residents attended a 5-day course on diagnosis and treatment of benign prostatic enlargement. Each of the residents performed three video-recorded TURP procedures. Between two of the procedures (on day 2 and 3, or 3 and 4) the residents underwent criterion-based practice using a simulator. The TURP procedure was evaluated using objective structured assessment of technical skills. Video-recordings of the procedures were analyzed on a minute-to-minute basis.
  
  
  RESULTS
  Mean practice time in the simulator was 198 minutes before reaching the criterion level. Comparison of the first and last TURP procedures showed an increase in autonomous operation time and time spent on resection, and a tendency to decreased hemostasis time without increased blood loss. The proportion of residents believed to be able to perform a simple TURP procedure increased from 10% to about 75%. Objective structured assessment of technical skills scores and self-evaluations were significantly improved. The scores increased significantly more with than without simulator practice. The resident's self-evaluations showed increased knowledge about the procedure and the technical equipment used. Patient follow-up showed no increased risks.
  
  
  CONCLUSIONS
  Practice in a simulator-based environment improves the skills and dexterity of urology residents when performing the procedure on patients, without increased risks for the patients.
authors.affiliation: Department of Urology, University Hospital Linköping, Linköping, Sweden. reidar.kallstrom@lio.se
authors.forename: Reidar
authors.initials: R
authors.lastname: Källström
authors.forename: Hans
authors.initials: H
authors.lastname: Hjertberg
authors.forename: Joar
authors.initials: J
authors.lastname: Svanvik
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000592:standards*; D003198:Computer Simulation; D003479:Curriculum; D004521:Educational Measurement; D005500:Follow-Up Studies; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D007858:Learning; D008297:Male; D011182:Postoperative Care; D011300:Preoperative Care; D011795:Surveys and Questionnaires; D020728:Transurethral Resection of Prostate / Q000193:education*; D014572:Urology / Q000193:education*; D014584:User-Computer Interface; D014741:Video Recording