The value of simulations and models for urology training and the transfer from simulation-based skills to performance in practice should be established in validation

Urology training today is still largely based on the apprenticeship model. This means that frequently procedural skill training is patient based. Currently, there are more and more calls to introduce new training methods and models to supplement the traditional educational approach,[1-4] partly owing to legal and ethical objections raised against patient-based training. A report entitled ‘Unintentional Injuries in Dutch Hospitals’ (Onbedoelde Schade in Nederlandse Ziekenhuizen) states that such injuries occur in 5.7% of all admissions and that the percentage is higher in surgical than in non-surgical departments [5]. Possibly, new, simulator-based training programmes that enable trainees to first practise procedures on simulators outside the operating theatre can go some way towards preventing morbidity and discomfort to patients. In November 2007, the Netherlands Health Care Inspectorate (Inspectie voor de Gezondheidszorg) published a report on adverse events in laparoscopic procedures,[1] in which all disciplines using endoscopic techniques were invited to develop and implement uniform national multi-disciplinary training programmes to reduce the risks that these techniques may pose to patients. The value of simulations and models for urology training and the transfer from simulation-based skills to performance in practice should be established in validation studies (Chapter 1). Simulation models can be validated by subjective and objective studies [6-9]. Subjective studies focus on experts’ opinions (content validity) and novices’ opinions (face validity) of training models. Objective studies involve experiments aimed at establishing whether 1) simulators discriminate between different levels of expertise and whether a learning curve is observable in novices who use the simulator for training (construct validity) and 2) performance in clinical practice is better following initial simulator training (criterion validity). Before validation studies are performed, it is advisable to first determine which models have been described and researched. It is also important to seek the opinions of programme directors, involved in the development and implementation of postgraduate surgical training programmes with regard to how simulator-based training in skills centres fits into training programmes.