A Modern Education Theory Approach to Development of a Benchtop Simulation Model for Ultrasound-Guided Percutaneous Nephrolithotomy

Objective: To develop and validate a high-fidelity, nonbiohazardous simulator model for the ultrasound-guided percutaneous nephrolithotomy procedure. Methods: We employed a systematic framework based on Delphi consensus and modern education theory to design a simulation model. Twelve expert surgeons provided input through a hierarchal task analysis and identified procedural tasks, anatomical landmarks, and potential errors. These were translated into engineering deliverables by a team of biomedical engineers and surgical educators. A prototype was developed using three-dimensional printing and hydrogel molding, followed by expert validation through recorded simulations and subsequent multicenter trails with 48 participants. Results: A hydrogel prototype with realistic anatomical features was created using results from the Delphi process. It received positive feedback in areas such as anatomy, procedural fidelity, and education effectiveness, with overall high satisfaction ratings. Validation studies showed a significant difference in performance between novices and experts. Residents demonstrated significant skill improvement and retention after repeated simulations. Conclusions: The developed simulator provides a realistic, effective training tool for urologic education, addressing the need for safer and more accessible surgical training modalities.