title: Effectiveness of procedural simulation in urology: a systematic review.
abstract: OBJECTIVE
  We analyzed studies validating the effectiveness and deficiencies of simulation for training and assessment in urology. We documented simulation types (synthetic, virtual reality and animal models), participant experience level and tasks performed. The feasibility, validity, cost-effectiveness, reliability and educational impact of the simulators were also evaluated.
  
  
  METHODS
  The MEDLINE®, EMBASE™ and PsycINFO® databases were systematically searched until September 2010. References from retrieved articles were reviewed to broaden the search.
  
  
  RESULTS
  The study included case reports, case series and empirical studies of training and assessment in urology using procedural simulation. The model name, training tasks, participant level, training duration and evaluation scoring were extracted from each study. We also extracted data on face, content and construct validity. Most studies suitably addressed content, construct and face validation as well as the feasibility, educational impact and cost-effectiveness of simulation models. Synthetic, animal and virtual reality models were demonstrated to be effective training and assessment tools for junior trainees. Few investigators looked at the transferability of skills from simulation to real patients.
  
  
  CONCLUSIONS
  Current simulation models are valid and reliable for the initial phase of training and assessment. For advanced and specialist level skill acquisition animal models can be used but availability is limited due to supply shortages and ethical restrictions. More research is needed to validate simulated environments for senior trainees and specialists.
authors.affiliation: Medical Research Council Centre for Transplantation, King's College London, King's Health Partners, Guy's Hospital, London, United Kingdom. k.ahmed@imperial.ac.uk
authors.forename: Kamran
authors.initials: K
authors.lastname: Ahmed
authors.forename: Muhammed
authors.initials: M
authors.lastname: Jawad
authors.forename: May
authors.initials: M
authors.lastname: Abboudi
authors.forename: Andrea
authors.initials: A
authors.lastname: Gavazzi
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.forename: Justin
authors.initials: J
authors.lastname: Vale
authors.forename: Mohammad Shamim
authors.initials: MS
authors.lastname: Khan
authors.forename: Prokar
authors.initials: P
authors.lastname: Dasgupta
mesh_terms: D002102:Cadaver; D003198:Computer Simulation; D004501:Education, Medical / Q000379:methods*; D008953:Models, Anatomic; D023421:Models, Animal; D014572:Urology / Q000193:education*