Hydrogel simulation-based training for HoLEP: technical performance, cognitive workload, and self-efficacy across residency training levels in AEEP
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Published on: May 6, 2020
Pedro Z Padovani1, Maxton Thoman1, Abbas Bader1
1Department of Urology, The University of Kansas Health System, 3901 Rainbow Boulevard, Mail Stop #3016, Kansas City, KS, 66160, USA.
Purpose:
Anatomic endoscopic enucleation of the prostate (AEEP) is an effective treatment for benign prostatic hyperplasia (BPH) but remains associated with a steep learning curve. We evaluated the impact of a hydrogel-based AEEP simulation model on technical performance, confidence, cognitive workload, and preliminary known-groups validity across residency training levels.
Methods:
A prospective simulation-based study included 17 urology residents (PGY1-5). Participants performed holmium laser enucleation of the prostate (HoLEP) using a hydrogel prostate model followed by standardized morcellation. Technical performance was assessed using the Objective Structured Assessment of Technical Skills (OSATS). Metrics included operative time, laser activation time, energy use, capsule perforations, and enucleation efficiency. Participants completed pre- and post-simulation self-assessments and the NASA Task Load Index (NASA-TLX).
Results:
Technical performance improved with increasing training level, with postgraduate year correlating with both OSATS (p = 0.043) and enucleation efficiency (p = 0.047). Self-assessment improved after simulation (p < 0.01), particularly among junior residents, with the greatest gains in AEEP-specific skills, including enucleation plane identification and troubleshooting (p < 0.001). Post-simulation self-assessment correlated with OSATS (rho = 0.72, p < 0.01), whereas confidence improvement did not (p = 0.45). Cognitive workload differed across training levels (p = 0.032), peaking in intermediate trainees. Performance differences across training levels provided preliminary evidence of known-groups validity.
Conclusions:
This study provides preliminary evidence of known-groups validity by differentiating technical performance in simulation based AEEP across residency training levels. These findings support the potential role of hydrogel-based simulation in residency training to improve trainee confidence and provide structured practice of core AEEP skills.