Assessing the Fidelity, Usability, and Educational Utility of a Comprehensive Training System for Ureteral Trauma...

Ureteral injuries, while rare, present a significant clinical challenge due to limited training opportunities. Current simulators for ureteral repair lack the fidelity needed for skill transfer in procedures like ureteroureterostomy and ureteroneocystostomy. To address this gap, we developed and evaluated a ureteral repair training curriculum including interactive multimedia assets and a modular physical training system, designed to train the skills necessary to successfully troubleshoot and repair a ureteral injury.

A prospective observational study was conducted at the 2024 Society for Genitourinary Reconstructive Surgeons meeting. Eighteen expert reconstructive urologists participated as subject matter experts and were randomly assigned to either ureteroureterostomy or ureteroneocystostomy. Participants reviewed the interactive curriculum, performed a procedure on the trainer, and completed an evaluation of the training system's fidelity, educational utility, and usability using structured surveys leveraging visual analogue scales with extremes of "0" indicating a "Poor Representation of Human Tissue" and "100" indicating a "Spot on representation of human tissue". Data were analyzed as means and weighted averages. This study was approved by the University of Washington Institutional Review Board (IRB) (#STUDY00015695).

Assessment of the system's fidelity was highly favorable. The synthetic ureter closely approximated human tissue, with strong ratings for the force required to puncture with a needle (81.4/100), suture drag (79.7/100), sharp dissection (77.5/100), and electrocautery dissection (86.6/100). Participants noted that improvements could be made to the weight (60.9/100) and surface texture (60.3/100) of the intestines. Overall, 94.4% of respondents felt the trainer provided above-average or higher training for ureteroureterostomy, and 92.3% reported the same for ureteroneocystostomy. The interactive curriculum was well-received: 95% of participants indicated that it promoted both engagement and skill retention, and 89% found it adaptable to different learning styles. Usability scores averaged 76/100, indicating an intuitive design that supports a realistic surgical experience.

The training system demonstrated substantial educational utility and fidelity, addressing an unmet need to obtain and maintain surgical skills for a rare but morbid surgical scenario. Integration of this system in training settings may enhance skill retention for the surgical management of ureteral trauma. These findings have direct implications for military surgery, where a reliable means of sustaining proficiency in ureteral trauma repair is critical to operational readiness.