title: Assessment of percutaneous renal access skills during Urology Objective Structured Clinical Examinations (OSCE).
abstract: BACKGROUND
  The first objective was to assess percutaneous renal access (PCA) skills of urology postgraduate trainees (PGTs) during the Objective Structured Clinical Examinations (OSCEs). The second objective was to determine whether previous experience with percutaneous nephrolithotomy (PCNL) improved performance.
  
  
  METHODS
  After obtaining ethics approval, we recruited PGTs from two urology programs in Quebec between postgraduate years (PGY-3 to PGY-5). Each trainee was asked to answer a short questionnaire regarding previous experience in endourologic procedures. After a 3-minute orientation on the PERC Mentor simulator (Simbionix, Cleveland, OH), each trainee was asked to perform task 4, where they had to correctly access all of the renal calyces and pop the balloons in a normal left kidney model. We collected and analyzed data from the questionnaire and the performance report generated by the simulator.
  
  
  RESULTS
  In total, 13 PGTs participated in this study. PGTs had performed a median of 200 (range: 50-1000) cystoscopies, 50 (range: 10-125) TURBTs, 30 (range: 0-100) TURPs, 5 (range: 0-50) laser prostatectomies, and 50 (range: 2-125) ureteroscopies prior to this OSCE. PGTs with previous PCNL experience (8/13) had performed a mean of 18.6 ± 6.3 PCNLs. PGTs with previous PCNL experience performed significantly better in terms of shorter fluoroscopy time (10 ± 1.5 vs. 5.1 ± 0.7 min; p = 0.04), fewer attempts required for successful puncture of the pelvi-calyceal system (PCS) (21 ± 2.3 vs. 13 ± 1.8; p = 0.02), and had significantly lower complications in terms of fewer infundibular injury (7.4 ± 1.5 vs. 2 ± 0.4; p = 0.004) and fewer PCS perforations (11 ± 1.7 vs. 4.5 ± 1.2; p = 0.01).
  
  
  CONCLUSIONS
  It is feasible to use the PERC Mentor simulator during OSCEs to assess PCA skills of urology PGTs. PGTs who had previous PCNL experience performed significantly better with fewer complications.
authors.affiliation: Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC; ; Department of Urology, Benha University Hospital, Benha University, Benha, Egypt;
authors.forename: Yasser A
authors.initials: YA
authors.lastname: Noureldin
authors.affiliation: Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC; ; Department of Urology, Suez Canal University, Ismailia, Egypt.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elkoushy
authors.affiliation: Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC;
authors.forename: Sero
authors.initials: S
authors.lastname: Andonian
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