The CREST simulation development process: training the next generation of "the pack"

The challenges of training and assessing endourologic skill have driven the development of new training systems. The Center for Research in Education and Simulation Technologies (CREST) has developed a team and a methodology to facilitate this development process.

Backwards design principles were applied. A panel of experts first defined desired clinical and educational outcomes. Outcomes were subsequently linked to learning objectives. Gross task deconstruction was performed and the primary domain was classified as primarily involving decision-making, psychomotor skill or communication. A more detailed cognitive task analysis was performed to elicit and prioritize relevant anatomy/tissues, metrics and errors. Reference anatomy was created using a digital anatomist and clinician working off of a clinical dataset. 3-D printing can facilitate this process. When possible, synthetic or virtual tissue behavior and textures were recreated using data derived from human tissue. Embedded sensors/markers and/or computer-based systems were used to facilitate the collection of objective metrics. Verification and validation occurred throughout the engineering development process.

Nine endourology-relevant training systems were created by CREST with this approach. Systems include basic laparoscopic skills (BLUS), vesicourethral anastomosis, pyeloplasty, cystoscopic procedures, stent placement, rigid and flexible ureteroscopy, Greenlight PVP (GL Sim), Percutaneous access with C-arm (CAT), Nephrolithotomy (NLM), and a vascular injury model. Mixed modalities have been employed including "smart" physical models, virtual reality, augmented reality and video. Substantial validity evidence for training and assessment has been collected. An open source manikin-based modular platform is under development by CREST with the Department of Defense that will unify these and other commercial tasks trainers through a common physiology engine, learning management system, and standardized data connection.

Using the CREST process has, and will ensure that the systems we create meet the needs of training and assessing endourologic skills.

Journal of endourology / Endourological Society. 2016 Sep 15 [Epub ahead of print]

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Robert M Sweet

University of Washington, Dept. of Urology , 1959 NE Pacific St , Seattle, Washington, United States , 98195 ; .