title: Comparative performance of high-fidelity training models for flexible ureteroscopy: Are all models effective?
abstract: OBJECTIVE
  We performed a comparative study of high-fidelity training models for flexible ureteroscopy (URS). Our objective was to determine whether high-fidelity non-virtual reality (VR) models are as effective as the VR model in teaching flexible URS skills.
  
  
  METHODS
  Twenty-one trained urologists without clinical experience of flexible URS underwent dry lab simulation practice. After a warm-up period of 2 h, tasks were performed on a high-fidelity non-VR (Uro-scopic Trainer™; Endo-Urologie-Modell™) and a high-fidelity VR model (URO Mentor™). The participants were divided equally into three batches with rotation on each of the three stations for 30 min. Performance of the trainees was evaluated by an expert ureteroscopist using pass rating and global rating score (GRS). The participants rated a face validity questionnaire at the end of each session.
  
  
  RESULTS
  The GRS improved statistically at evaluation performed after second rotation (P<0.001 for batches 1, 2 and 3). Pass ratings also improved significantly for all training models when the third and first rotations were compared (P<0.05). The batch that was trained on the VR-based model had more improvement on pass ratings on second rotation but could not achieve statistical significance. Most of the realistic domains were higher for a VR model as compared with the non-VR model, except the realism of the flexible endoscope.
  
  
  CONCLUSIONS
  All the models used for training flexible URS were effective in increasing the GRS and pass ratings irrespective of the VR status.
authors.affiliation: Department of Urology, Muljibhai Patel Urological Hospital, Nadaid, Gujarat - 387 001, India.
authors.forename: Shashikant
authors.initials: S
authors.lastname: Mishra
authors.forename: Rajan
authors.initials: R
authors.lastname: Sharma
authors.forename: Akhilesh
authors.initials: A
authors.lastname: Kumar
authors.forename: Pradeep
authors.initials: P
authors.lastname: Ganatra
authors.forename: Ravindra B
authors.initials: RB
authors.lastname: Sabnis
authors.forename: Mahesh R
authors.initials: MR
authors.lastname: Desai