Objective Assessment and Standard Setting for Basic Flexible Ureterorenoscopy Skills Among Urology Trainees Using...

Area of Science:

• Urology
• Medical Education
• Surgical Simulation

Background:

• Flexible ureterorenoscopy (fURS) is a key urologic procedure.
• Objective assessment of resident proficiency in fURS is needed.
• Simulation offers a controlled environment for performance evaluation.

Purpose of the Study:

• To objectively assess graduating urology resident performance in fURS using a simulation model.
• To establish an entrustability standard for fURS proficiency.
• To identify trainees needing additional support.

Main Methods:

• Chief urology residents and attending endourologists performed a standardized fURS task on a simulation model.
• Performances were video-recorded and scored by experts and crowd-workers using the Ureteroscopic Global Rating Scale and entrustability scores.
• The Borderline Group (BG) method was used for standard setting.

Main Results:

• 44 participants (40 residents, 4 faculty) were tested; 83% had performed over 50 fURS cases.
• Only 47.7% of residents were deemed "entrustable" by experts, and 61.4% by crowd-workers.
• Entrustability benchmarks were set at 11.8/20 (experts) and 11.4/20 (crowd-workers), with pass rates of 56.9% and 61.4% respectively.

Conclusions:

• Absolute performance standards and benchmarks were established for simulated fURS.
• Approximately 60% of residents met the defined entrustability benchmark.
• These findings support using simulation benchmarks for early identification of residents requiring remediation in fURS.