Is there a place for virtual reality simulators in assessment of competency in percutaneous renal access?

To assess competency of urology post-graduate trainees (PGTs) in percutaneous renal access (PCA). Upon obtaining ethics approval and informed consents, PGTs between post-graduate years (PGY-3 to PGY-5) from all four urology programs in Qu,bec were recruited. PCA competency of each participant was assessed objectively by performing task 4 on the PERC Mentor (TM) simulator, where they had to correctly access and pop 7 balloons in 7 different renal calyces and subjectively by the validated Percutaneous Nephrolithotomy-Global Rating Scale (PCNL-GRS). A total of 26 PGTs with a mean age of 29.2 +/- A 0.7 years participated in this study. When compared with the 21 PGTs without practice, all 5 PGTs who had practiced on the simulator were competent (p = 0.03), performed the task with significantly shorter operative time (13.9 +/- A 0.7 vs. 4.4 +/- A 0.4 min; p < 0.001) and fluoroscopy time (9.3 +/- A 0.6 vs. 3.4 +/- A 0.4 min; p < 0.001), and had significantly higher PCNL-GRS scores (13 +/- A 0.6 vs. 20.6 +/- A 1; p < 0.001) and successful attempts to access renal calyces (23 +/- A 5 vs. 68.7 +/- A 11; p = 0.001). According to a pass score of 13/25, thirteen PGTs were competent. Competent PGTs performed the task with significantly shorter fluoroscopy time (9.8 vs. 6.5 min; p = 0.01) and higher percentage of successful attempts to access renal calyces (p < 0.001), higher PCNL-GRS scores (p < 0.001), and lower complications (p = 0.01). The PCNL-GRS in combination with the PERC Mentor (TM) simulator was able to differentiate between competent and non-competent PGTs.