title: The Surgical Skill of a Novice Trainee Manifests in Time-Consuming Exercises of a Virtual Simulator Rather Than a Quick-Finishing Counterpart: A Concurrent Validity Study Using an Urethrovesical Anastomosis Model.
abstract: OBJECTIVE
  The purpose of this study is to determine an optimal training curriculum using a robotic virtual simulator (RVS) that enables unexperienced trainees to perform a complex task in a hands-on setting.
  
  
  METHODS
  This study was conducted in 2 phases. In the RVS phase, 43 participants sequentially completed 12 exercises consistent with all primary exercises in the EndoWrist manipulation and advanced needle-driving category, until the overall score reached more than 80% by repeated practice. In the hands-on phase using a robotic surgical system, 10 randomly selected trainees performed 8 sutures once, simulating urethrovesical anastomosis, and the console time was recorded.
  
  
  RESULTS
  The median total time and total attempts for the RVS phase was 195.2 minutes and 54 times, respectively. The trainees were divided by median total time, and times to accomplish each RVS exercise were then compared between the early- and the late-completion groups; among 12 exercises trained, 6 exercises (prolonged course) requiring significantly more time in the late-completion group were identified. The prolonged course occupied 88.18% of the total time and 77.61% of the total attempts. For participants the in hands-on phase, a multiple linear regression model showed that the time to accomplish the prolonged course was a single independent predictor of the console time (R(2) = 0.524, B = 0.05; p = 0.018).
  
  
  CONCLUSIONS
  After establishment of a high standard cutoff score, the time spent for the prolonged course showed a significant association with console time in hands-on training simulating urethrovesical anastomosis, implying educational efficacy of training involving time-consuming exercise in performance of a complex task.
authors.affiliation: Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea.
authors.forename: Phil Hyun
authors.initials: PH
authors.lastname: Song
authors.affiliation: Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea. Electronic address: urokyh@naver.com.
authors.forename: Young Hwii
authors.initials: YH
authors.lastname: Ko
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000193:education; D002983:Clinical Competence; D003198:Computer Simulation; D003479:Curriculum; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012371:Robotics; D000066908:Simulation Training; D013043:Specialties, Surgical / Q000193:education*; D013997:Time Factors; D014521:Urethra / Q000601:surgery; D001743:Urinary Bladder / Q000601:surgery; D014584:User-Computer Interface; D055815:Young Adult
keywords: Interpersonal and Communication Skills; Practice-Based Learning and Improvement; Systems-Based Practice; education; radical prostatectomy; urethrovesical anastomosis; virtual simulator