title: Is there a place for virtual reality simulators in assessment of competency in percutaneous renal access?
abstract: OBJECTIVE
  To assess competency of urology post-graduate trainees (PGTs) in percutaneous renal access (PCA).
  
  
  METHODS
  Upon obtaining ethics approval and informed consents, PGTs between post-graduate years (PGY-3 to PGY-5) from all four urology programs in Québec were recruited. PCA competency of each participant was assessed objectively by performing task 4 on the PERC Mentor™ simulator, where they had to correctly access and pop 7 balloons in 7 different renal calyces and subjectively by the validated Percutaneous Nephrolithotomy-Global Rating Scale (PCNL-GRS).
  
  
  RESULTS
  A total of 26 PGTs with a mean age of 29.2 ± 0.7 years participated in this study. When compared with the 21 PGTs without practice, all 5 PGTs who had practiced on the simulator were competent (p = 0.03), performed the task with significantly shorter operative time (13.9 ± 0.7 vs. 4.4 ± 0.4 min; p < 0.001) and fluoroscopy time (9.3 ± 0.6 vs. 3.4 ± 0.4 min; p < 0.001), and had significantly higher PCNL-GRS scores (13 ± 0.6 vs. 20.6 ± 1; p < 0.001) and successful attempts to access renal calyces (23 ± 5 vs. 68.7 ± 11; p = 0.001). According to a pass score of 13/25, thirteen PGTs were competent. Competent PGTs performed the task with significantly shorter fluoroscopy time (9.8 vs. 6.5 min; p = 0.01) and higher percentage of successful attempts to access renal calyces (p < 0.001), higher PCNL-GRS scores (p < 0.001), and lower complications (p = 0.01).
  
  
  CONCLUSIONS
  The PCNL-GRS in combination with the PERC Mentor™ simulator was able to differentiate between competent and non-competent PGTs.
authors.affiliation: Division of Urology, McGill University Health Center, McGill University, 1001 Boul Decarie, Suite D05.5331, Montreal, QC, H4A 3J1, Canada.|Department of Urology, Benha University Hospital, Benha University, Benha, Egypt.
authors.forename: Yasser A
authors.initials: YA
authors.lastname: Noureldin
authors.affiliation: Division of Urology, McGill University Health Center, McGill University, 1001 Boul Decarie, Suite D05.5331, Montreal, QC, H4A 3J1, Canada.
authors.forename: Nader
authors.initials: N
authors.lastname: Fahmy
authors.affiliation: Division of Urology, McGill University Health Center, McGill University, 1001 Boul Decarie, Suite D05.5331, Montreal, QC, H4A 3J1, Canada.
authors.forename: Maurice
authors.initials: M
authors.lastname: Anidjar
authors.affiliation: Division of Urology, McGill University Health Center, McGill University, 1001 Boul Decarie, Suite D05.5331, Montreal, QC, H4A 3J1, Canada. Sero.Andonian@muhc.mcgill.ca.
authors.forename: Sero
authors.initials: S
authors.lastname: Andonian
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation; D005260:Female; D006801:Humans; D008297:Male; D009403:Nephrostomy, Percutaneous / Q000592:standards*; D014584:User-Computer Interface
keywords: Clinical competence; Computer simulation; Outcomes assessment; Percutaneous nephrolithotomy; Virtual systems