This systematic review sought to highlight the evidence supporting the real-world utility endourological training outside of the clinical environment, the degree of uptake in urology training programs, and the barriers that have prevented simulation and curricular training difficult to incorporate into postgraduate medical education. We felt that by focusing on the educational literature that has demonstrated real-world clinical benefit to participants, we may increase the appeal of incorporating such training methods into existing endourology curricula. We feel it is logical that utilizing educational interventions with evidence supporting their ability to improve the technical ability of trainees in the clinical world will yield the highest educational value.
In order to introduce new modalities in urological curricula, they have to be tested appropriately. The outcome of our systematic review shows that there is a paucity of literature that has demonstrated that these interventions can bring about meaningful improvement, with too much focus on the most basic aspects of educational validity like reliability and generalizability. With this paper, we underscore the imperative that medical education scholars must move away from focusing on assessment design, to next exploring the applicability of those training models in the clinical environment. By measuring the effect of these educational interventions on real-world performance, and incorporating patient outcomes as measures of educational quality, we will be able to more intelligently select which simulation and ex vivo training methods truly are of value. Time is such a precious resource in postgraduate medical education, and therefore we should focus our efforts on those aspects of education with evidence demonstrating positive consequences for our health care system.
Looking ahead, it is exciting to see the emergence of technology-driven educational tools and assessments. The use of virtual and augmented reality-based simulation has vastly increased the fidelity of these interventions and has made it possible to incorporate real-world elements of patient care into the simulation environment, such as CT or MRI images. These innovations are helping to rapidly push the field of medical education forward and will allow us to more readily understand the impact that procedural training in the simulation laboratory can have on the well-being of our patients.
Written by: Ishan Aditya, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada, and Mitchell G Goldenberg, MBBS, PhD, Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
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