Abstracts EAU19 – 34th Annual EAU Congress

826 Simulation in urological training and education (SIMULATE): A randomised controlled

clinical and educational trial to determine the effect of structured surgical simulation
training

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Aydin A. 1 , Ahmed K. 1 , Raison N. 1 , Abe T. 2 , Gözen A.S. 3 , Moltzahn F. 4 , Knoll T. 5 , Zhu W. 6 , Kunit T. 7 , Skolarikos A. 8 , Sfakianos J. 9 ,

Lantz A. 10 , Chew B. 11 , Thalmann G. 4 , Rassweiler J. 3 , Shinohara N. 2 , Tewari A. 9 , Zeng G. 6 , Sarıca K. 12 , Van Hemelrijck M. 13 , Ahmed

H.U. 14 , Khan M.S. 1 , Dasgupta P. 1 , SIMULATE

1
King's College London, MRC Centre for Transplantation, London, United Kingdom, 2Hokkaido University Hospital, Dept. of Urology, Sapporo,

Japan, 3SLK-Kliniken, University of Heidelberg, Dept. of Urology, Heilbronn, Germany, 4University of Bern, Dept. of Urology, Bern, Switzerland,
5
Sindelfingen-Bo?blingen Medical Centre, University of Tu?bingen, Dept. of Urology, Sindelfingen, Germany, 6First Affiliated Hospital of

Guangzhou Medical University, Dept. of Urology, Gunagzhou, China, 7Paracelsus Medical Private University, Dept. of Urology, Salzburg, Austria,
8
Sismanoglio Hospital, Athens Medical School, Dept. of Urology, Athens, Greece, 9Icahn School of Medicine at Mount Sinai, Dept. of Urology,

New York, United States of America, 10Dalhousie University, Dept. of Urology, Halifax, Canada, 11University of British Columbia, Dept. of Urology,

Vancouver, Canada, 12Kafkas University, Dept. of Urology, Kars, Turkey, 13King's College London, Division of Cancer Studies, London, United

Kingdom, 14Imperial College London, Dept. of Surgery and Cancer, London, United Kingdom

Introduction & Objectives:

With increasing challenges in surgical training, supplementary simulation has been adopted globally to provide means for safe practice prior
to operating room (OR) training and experience. This study aims to evaluate the effectiveness of simulation-based training in urology, using
ureteroscopy (URS) as an index procedure. The primary aim is to assess the number of procedures required to achieve proficiency in URS for junior
urologists who have and have not undergone supplementary simulation training. It also aims to determine whether simulation-based practice leads
to better patient outcomes (48 hr complication rates and stone-free status) and seek opinion about the feasibility, acceptability and educational
value of simulation-based training.

Materials & Methods:

This international, multi-centre, prospective, randomised parallel controlled trial has recruited urology residents from the United Kingdom (n=31),
Europe (n=26), Japan (n=10), China (n=19) and North America (n=8), with no more than 10 full ureteroscopy experience and structured simulation
training in URS. Recruits from each region were randomised into either simulation-based training (SBT, n=46) vs. non-simulation-based training
(NSBT, n=48) groups. Five independent training sessions were conducted for the SBT arm of the study in Manchester (n=15), Salzburg (n=15),
Hokkaido (n=5), Guangzhou (n=9) and London (n=4), utilising an expert-developed curriculum. The NSBT arm continued OR-led training under
the supervision of experienced trainers, as is current practice. Both groups will be assessed for 25 procedures in the OR and/or over 18 months,
during which validated assessment scales - both procedure-specific (URSAS) and generic (OSATS) - are used for assessment of technical and
non-technical skills (NoTSUS). At the end of each educational intervention, a final survey was distributed to the SBT arm, consisting of qualitative
and quantitative fields to explore feasibility, acceptability and educational value of simulation-based training.

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Abstracts EAU19 – 34th Annual EAU Congress

Results: SBT participants rated that the training significantly improved their skills (mean: 4.2/5) and that they gained transferrable skills (mean: 4.2/
5). A One-way ANOVA test revealed significant improvement (p=0.0018) with consecutive cases throughout the curriculum.

Conclusions:
SIMULATE is the first international multi-centre study investigating the effect and transferability of supplementary simulation training on OR
performance and patient outcomes. Participants are currently in the follow-up phase of the RCT for assessment of proficiency.

Eur Urol Suppl 2019; 18(1);e1109