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Published on: October 16, 2013
Consensus-informed Development of Scoring Systems for Intermediate Laparoscopic Simulation Modules: An ESU
Arianna Pischetola1, Moises Rodriguez Socarras2, Tiago Ribeiro de Oliveira3
1Faculty of Medicine, Campus Bio-Medico University, Rome, Italy.
Background And Objective:
Competency-based and standardised surgical training has become essential in urological education. The European School of Urology (ESU) established the Standardisation in Surgical Education initiative to develop a validated, competency-based surgical training. The ESU Laparoscopic Workgroup aims to develop two intermediate-level laparoscopic simulation modules, Partial Nephrectomy (PN) and Major Vessel Injury (MVI), and develop standardised performance metrics and scoring criteria for the intermediate laparoscopic ESU curriculum.
Design Setting And Participants:
Modules were evaluated during hands-on training courses across multiple European congresses. PN was completed by 27 participants (four experts, 23 residents); MVI by 41 participants (29 experts and 12 residents). Predefined performance parameters were derived from a previously published Delphi consensus defining the ESU Laparoscopic Urological Skills 2 curriculum and included procedure time, tissue handling, technical precision, completeness of resection/closure, haemostasis, and functional outcome.
Outcome Measurements And Statistical Analysis:
Completion times were assessed using the Mann-Whitney U test for continuous variables. Qualitative performance parameters were recorded as criterion-referenced educational indicators and summarised descriptively. Observed performance patterns, together with expert consensus, were used to inform the development of candidate scoring frameworks.
Results:
Experts completed both modules in shorter median times compared with residents, for both modules (PN: 21:36 [interquartile range {IQR} 17:49-26:21] min vs 42:00 [IQR 36:35-43:26] min, p = 0.001; MVI: 5:24 [IQR 4:57-8:04] min vs 16:48 [IQR 11:12-27:15] min, p < 0.001). Qualitative categorical parameters (tissue handling, resection completeness, and haemostasis) showed descriptive patterns favouring expert participants and were reported narratively. Informed by these observed performance patterns and the underlying Delphi consensus, structured, domain-based candidate scoring frameworks were proposed for both modules to support future validation and curriculum implementation.
Conclusions:
This study supports the feasibility and educational relevance of two intermediate laparoscopic simulation modules within the ESU LUS2 curriculum. Building on a previously established Delphi consensus and informed by observed performance patterns, we propose preliminary, consensus-informed scoring frameworks intended to guide structured assessment and feedback. These findings should be regarded as a foundational step toward future validation and refinement in larger cohorts prior to formal implementation.
