Introduction: We evaluated the use of the GreenLight Simulator
(GL-SIM) (American Medical Systems, Guelph, ON) in the skill
assessment of postgraduate trainees (PGTs) in photoselective
vaporization of the prostate (PVP). We also sought to determine
whether previous PVP experience or GL-SIM practice improved
performance.
Methods: PGTs in postgraduate years (PGY-3 to PGY-5) from all 4
Quebec urology training programs were recruited during 2 annual
Objective Structured Clinical Examinations (OSCEs). During a
20-minute OSCE station, PGTs were asked to perform 2 exercises:
(1) identification of endoscopic landmarks and (2) a PVP of a 30-g
normal prostate. Grams vaporized, global scores, and number of
correct anatomical landmarks were recorded and correlated with
PGY level, practice on the GL-SIM, and previous PVP experience.
Results: In total, 25 PGTs were recruited at each OSCE, with 13
PGTs participating in both OSCEs. When comparing scores from
the first and second OSCEs, there was a significant improvement
in the number of grams vaporized (2.9 vs. 4.3 g; p = 0.003) and
global score (100 vs. 165; p = 0.03). There was good correlation
between the number of previously performed PVPs and the global
score (r = 0.4, p = 0.04). Similarly, PGTs with previous practice on
the GL-SIM had significantly higher global score (100.6 vs. 162.6;
p = 0.04) and grams vaporized (3.1 vs. 4.1 g; p = 0.04) when compared
with those who did not practice on GL-SIM. Furthermore,
there were significantly more competent PGTs among those
who had previously practiced on the GL-SIM (32.7% vs. 10.2%;
p = 0.009). PGY level did not significantly affect grams vaporized
or global score (p > 0.05).
Conclusion: Performance on the GL-SIM at OSCEs significantly
correlated with previous practice on the GL-SIM and previous PVP
experience rather than PGY level. Furthermore, there were significantly
more competent PGTs among those who had previously
practiced on the GL-SIM. |
