Page 4 - CUA2019 Abstracts - Miscellaneous/Other

Poster session 5: training & Evaluation

whether the attitudes and experience of graduating urology residents References
have changed. We set out to evaluate the attitudes and experience of 1. Thomas AZ, Giri SK, Meagher D, et al Avoidable iatrogenic compli-
graduating urology residents in prescribing opioid/non-opioid analgesia cations of urethral catheterization and inadequate intern training in
for acute (AP), chronic non-cancer (CnC), and chronic cancer (CC) pain. a tertiary care teaching hospital. BJU Int 2009;104:1109-12. https://
Methods: Thirty-five graduating urology residents were surveyed at a doi.org/10.1111/j.1464-410X.2009.08494.x
review course in 2018. The survey consisted of open-ended and close- 2. Cohen A, Nottingham C, Packiam V, et al. Attitudes and knowledge
ended five-point Likert scale questions. Descriptive statistics, Mann- of urethral catheters: A targeted educational intervention. BJU Int
Whitney U-test, and Student’s t-test were performed. 2016;118:654-9. https://doi.org/10.1111/bju.13506
Results: Thirty-two responses were collected. The vast majority agreed 3. Zhong X, Wang P, Feng J, et al. Novel transparent urinary tract simu-
that formal training in managing AP/CnC/CC is valuable (91%/78%/81%). lator improves teaching of urological operation skills at a single insti-
Most found their training in CnC/CC management to be inadequate and tution. Urol Int 2015;95:38-43. https://doi.org/10.1159/000375129
are unaware of any prescribing guidelines; 66% never counsel patients 4. Rodríguez-Díez MC, Díez N, Merino I, et al. Simulators help
on how to dispose of excess opioids. In general, 88% are comfortable improve student confidence to acquire skills in urology. Actas Urol
prescribing opioids, whereas most are very uncomfortable prescribing Esp Engl Ed 2014;38:367-72.
cannabis or antidepressants (100%/78%). Residents reported the Acute 5. Grober ED, Hamstra SJ, Wanzel KR, et al. The educational impact of
Pain Service as the highest rated resource for information, and dedicated bench model fidelity on the acquisition of technical skill: The use of
textbooks the least. clinically relevant outcome measures. Ann Surg 2004;240:374-81.
Conclusions: This survey demonstrated that experience in pain manage- https://doi.org/10.1097/01.sla.0000133346.07434.30
ment remains variable among urology residents. Knowledge gaps remain,
particularly in the management of CnC and CC pain. UP-5.1
Reference
1. Pace J, Jaeger M, Nickel JC, et al. Pain management in urology Analysis of forces in laparoscopy: The deconstruction of an
training: A national survey of senior residents. Can Urol Assoc J intracorporeal suturing task 2 2
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2013;7:456-61 https://doi.org/10.5489/cuaj.1562 Kai-Ho Fok , Sophia Duong , Brian Carrillo , Justin T. Gerstle , Georges
Azzie , Monica Farcas 1
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1 Urology, University of Toronto, Toronto, ON, Canada; General and
MP-5.12 Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada
Assessment of a novel 3D-printed urinary catheter insertion Introduction: An intracorporeal suturing task simulator has been devel-
model for undergraduate medical students oped that can measure forces in real time during the performance of
Charlie Gillis , Nicole Bishop , Adam Dubrowski , David Harvey 4 the task. These forces have been described and have been shown to be
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2,3
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1 School of Medicine, Memorial University, St. John’s, NL, Canada; greater in larger-size simulators. We analyze the forces on deconstructed
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2 MUNMed3D, Memorial University, St. John’s, NL, Canada; Emergency task segments to allow for targeted assessment and teaching.
Medicine, Memorial University, St. John’s, NL, Canada; Surgery, Memorial Methods: Participants performed a defined intracorporal suturing task on a
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University, St. John’s, NL, Canada laparoscopic simulator. Expertise level was assigned based on case num-
Introduction: Urinary catheter insertion is a mandatory procedure taught ber. Real-time force and torque data were collected in three 3 degrees of
during medical school. It is imperative that learners are provided the freedom using a custom-designed, force-sensing platform. The task was
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opportunity to practice the procedure, as improper catheterization tech- deconstructed into four segments: pull-through, double-throw knot, first
nique can result in urethral trauma and contribute to urinary tract infec- single-throw knot, and second single-throw knot. Force analysis param-
tions. Simulation training offers the advantage of avoiding patient harm eters (FAPs) were calculated for each of the segments. FAPs included
1,2
while allowing learners to feel comfortable to learn from their mistakes, maximum, mean, and number of extreme force events. Outcomes were
resulting in increased user confidence and shortening the learning curve analyzed using one-way ANOVAs and paired sample t-tests (p<0.05).
3,4
for basic procedures. 3D-printed simulation models are anatomically Results: One-hundred two participants were recorded (20 experts, 52
accurate, low-cost, reusable, and effective for teaching basic procedural intermediates, 30 novices). The largest differences were seen in the “dou-
skills. This study aims to assess the self-rated effectiveness of the 3D ble-throw knot segment.” In this segment, significant differences were
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model in increasing student confidence and preparedness. identified in mean forces exerted in the “side-to-side” direction. Experts
Methods: First- and second-year undergraduate medical students (n=40) exerted a mean force to the right, whereas novices exerted a mean force to
participated in procedural skills training sessions using the 3D-printed the left. Congruently, differences were also seen in this segment between
model (Fig. 1). The students were provided with didactic teaching from novices, intermediates, and experts in the torque applied in the “side-to-
a urologist, a hands-on demonstration, and then allowed to practice the side axis.” Similar differences were not found in other segments. In the
procedure using the 3D model. Students were subsequently asked to “first single throw segment,” the novices had a significantly larger number
complete a survey to evaluate their experience and the 3D model as an of extreme force events in the “up-and-down” direction.
educational tool. Conclusions: An ability to perform real-time assessment of forces during
Results: All respondents who completed the survey indicated that they an intracorporeal suturing task is demonstrated. Deconstruction of the task
would use and recommend the use of the 3D-printed model to augment into segments gains further insights that distinguish expertise level. Further
their ongoing training and education. The students rated the model an investigation on specific maneuvers may better characterize expertise and
average of 4.06±0.74 out of 5 for increasing preparedness in completing allow for more effective teaching/evaluation.
the procedure on a real patient, and an average of 4.39±0.80 out of 5 This paper has a figure, which may be viewed online at:
for increasing confidence in this procedure. https://2019.cua.events/webapp/lecture/152
Conclusions: Preclerkship undergraduate medical students found the References
3D-printed male catheter insertion model to be a useful learning tool 1. Gavrilovic B, Fahy AS, Carrillo B, et al. Development of an open-
with accurate anatomical representations and technical qualities. The source laparoscopic simulator capable of motion and force assess-
3D-printed model can be beneficial for increasing learner confidence ment: High tech at low cost. J Laparoendosc Adv Surg Tech A
and preparedness when completing a catheter insertion, allowing for the 2018;28:1253-60. https://doi.org/10.1089/lap.2018.0126
opportunity to practice on a low-cost, accessible simulator. 2. Fahy AS, Jamal L, Gavrilovic B, et al. The impact of simulator size
This paper has a figure, which may be viewed online at: on forces generated in the performance of a defined intracorporeal
https://2019.cua.events/webapp/lecture/149 suturing task: A pilot study. J Laparoendosc Adv Surg Tech A 2018
Jul 13. [Epub ahead of print]. https://doi.org/10.1089/lap.2018.0255
CUAJ • June 2019 • Volume 13, Issue 6(Suppl5) S115