title: Holmium Laser Enucleation of the Prostate: Simulation-Based Training Curriculum and Validation.
abstract: OBJECTIVE
  To evaluate the face, content, and construct validity of a novel virtual reality simulator for holmium laser enucleation of the prostate (HoLEP) and to assess its feasibility and acceptability as a training model.
  
  
  METHODS
  This prospective observational study recruited 53 participants, comprising of 3 groups: HoLEP experts (n = 11), intermediates (n = 24), and novices (n = 18). All participants received an educational package and a 15-minute familiarization exercise with the simulator. All participants then carried out a full enucleation on an identical 60 cm(3) virtual prostate. Performance was assessed using in-built simulator metrics, and a questionnaire was distributed assessing face and content validity, as well as feasibility, and acceptability. Novice, intermediate, and expert groups were compared using the Mann-Whitney U test.
  
  
  RESULTS
  Construct validity data revealed significant differences in enucleation efficiency (grams enucleated per hour) when comparing experts to intermediates (P = .003), experts to novices (P <.001), and intermediates to novices (P = .001). Face validity was rated by experts as acceptable, with a mean score of 5.6 out of 10 when asked to rate the overall realism. Content validity questions showed that 85% of participants agreed that simulator-based assessment is essential for patient safety and 87% agreed that there was a role for a validated virtual reality simulator for use in HoLEP training.
  
  
  CONCLUSIONS
  This study established face, content, and construct validity for this novel virtual reality HoLEP simulator. The majority of participants also thought that it is a feasible and acceptable model for HoLEP training.
authors.affiliation: MRC Centre for Transplantation, King's College London, Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, London, United Kingdom.
authors.forename: Cameron
authors.initials: C
authors.lastname: Kuronen-Stewart
authors.affiliation: MRC Centre for Transplantation, King's College London, Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, London, United Kingdom. Electronic address: kamran.ahmed@kcl.ac.uk.
authors.forename: Kamran
authors.initials: K
authors.lastname: Ahmed
authors.affiliation: MRC Centre for Transplantation, King's College London, Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, London, United Kingdom.
authors.forename: Abdullatif
authors.initials: A
authors.lastname: Aydin
authors.affiliation: Department of Urology, Maidstone Hospital, Maidstone and Turnbridge NHS Trust, Maidstone, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Cynk
authors.affiliation: Department of Urology, Centre for Health, Horley, Surrey, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Miller
authors.affiliation: MRC Centre for Transplantation, King's College London, Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, London, United Kingdom.
authors.forename: Ben
authors.initials: B
authors.lastname: Challacombe
authors.affiliation: MRC Centre for Transplantation, King's College London, Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, London, United Kingdom.
authors.forename: Muhammad Shamim
authors.initials: MS
authors.lastname: Khan
authors.affiliation: MRC Centre for Transplantation, King's College London, Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, London, United Kingdom.
authors.forename: Prokar
authors.initials: P
authors.lastname: Dasgupta
authors.affiliation: Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
authors.forename: Tevita F
authors.initials: TF
authors.lastname: Aho
authors.affiliation: MRC Centre for Transplantation, King's College London, Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, London, United Kingdom.
authors.forename: Rick
authors.initials: R
authors.lastname: Popert
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D003198:Computer Simulation; D003479:Curriculum; D004502:Education, Medical, Continuing; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000601:surgery*; D006113:United Kingdom; D013520:Urologic Surgical Procedures / Q000193:education* / Q000379:methods; D014584:User-Computer Interface; D055815:Young Adult