Training, Simulation, the Learning Curve, and How to Reduce Complications in Urology.

CONTEXT: Urology is at the forefront of minimally invasive surgery to a great extent. These procedures produce additional learning challenges and possess a steep initial learning curve. Training and assessment methods in surgical specialties such as urology are known to lack clear structure and often rely on differing operative flow experienced by individuals and institutions.
OBJECTIVE: This article aims to assess current urology training modalities, to identify the role of simulation within urology, to define and identify the learning curves for various urologic procedures, and to discuss ways to decrease complications in the context of training. EVIDENCE ACQUISITION: A narrative review of the literature was conducted through December 2015 using the PubMed/Medline, Embase, and Cochrane Library databases. EVIDENCE SYNTHESIS: Evidence of the validity of training methods in urology includes observation of a procedure, mentorship and fellowship, e-learning, and simulation-based training. Learning curves for various urologic procedures have been recommended based on the available literature. The importance of structured training pathways is highlighted, with integration of modular training to ensure patient safety.
CONCLUSIONS: Valid training pathways are available in urology. The aim in urology training should be to combine all of the available evidence to produce procedure-specific curricula that utilise the vast array of training methods available to ensure that we continue to improve patient outcomes and reduce complications. PATIENT
SUMMARY: The current evidence for different training methods available in urology, including simulation-based training, was reviewed, and the learning curves for various urologic procedures were critically analysed. Based on the evidence, future pathways for urology curricula have been suggested to ensure that patient safety is improved.