Presented by: Spencer mossack MD
Rush University Medical Center

Introduction

The learning curve for residents in training for obtaining percutaneous renal access during PCNL is steep. Simulation models may help supplement clinical training for this complex skill. We evaluated NASA-TLX workload profiles of urology residents during simulated percutaneous renal access with ultrasound or fluoroscopic guidance in bench top models.

Materials

During the 2023 Chicago Urologic Society meeting, a PCNL simulation workshop was held for urology residents from programs across the city and state. It included modules for obtaining fluoroscopic and ultrasound-guided percutaneous renal access with guidance from Endourology fellowship trained faculty. Each participant subsequently completed a general questionnaire, as well as a NASA-TLX questionnaire for each model. NASA-TLX domain scores for fluoroscopy vs. ultrasound models, and junior (PGY1-3) vs. senior (PGY4-6) residents were compared using standardized t-tests. 

Results

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A total of 22 junior and 13 senior residents participated in the workshop. Only senior residents reported being exposed to >20 PCNL cases in training. The majority of residents found both simulations to be “very” or “extremely” useful. The highest mean (SE) TLX domain score for the ultrasound model was for “performance” (43.06 (4.2)), compared with “temporal demand” for the fluoroscopy model (47.03 (3.7)). There were no statistically significant differences in any of the mean NASA-TLX domain scores for the ultrasound vs. fluoroscopy models. Similarly, there were no differences in mean NASA-TLX domain scores for junior vs. senior residents. The models were rated equally with respect to overall perception, ease, usefulness, and real-life representation.

Conclusion

Bench top models for ultrasound and fluoroscopic guided PCNL access appear to provide value for resident training, with residents reporting positive overall perceptions of their experience. Urology resident workload during the simulation exercises was low, with each of the NASA-TLX domain scores <50.

Funding

None

Co-Authors

Luke Reynolds, MD
University of Chicago

Alexander Chow, MD
Rush University Medical Center

Christopher Coogan, MD
Rush University Medical Center

Ephrem Olweny, MD
Rush University Medical Center