Simulator Based Development of “Trans-Urethral Resection of Prostate” Skills and implementation of “Global Rating Scale” Evaluation System in Urology Postgraduate training

AuthorKashifuddin Qayoom soomro, Zakir Rajpar, Imran Memon, Shafiq-ur-Rehman

Introduction & Objective

After the introduction of simulators in urology, education in urology has evolved significantly. Specially in endourology, development of Transurethral Resection of Prostate (TURP) skills are shifted from “direct on patient” to simulator based learning. we evaluated the development of TURP procedure skills based on virtual reality simulator (VirtaMed | UroSim™) and assessment of skills based on Global Rating Scale (GRS) evaluation system.


Of 17 participants, 4 were Urology faculty and 13 postgraduate urology trainees. All participants performed TURP basic procedural skills on simulator before attempting TURP full procedure (Easy 1 mode). Five attempts of real time TURP full procedure were performed by all candidates. Participants were allowed to resect maximum possible prostate tissue (goal =>85%). Skills were assessed in terms of Resection, Bleeding control and safety. Data was obtained from Simulator based scores and objective assessment based on GRS scores. We analyzed the data from the first and fifth attempt of all participants, and differences were compared.


In faculty, there was no significant deference in Resection score (112+8.6/120:p=0.18), Bleeding control score (70/70), Safety score (70+14.14/80:p=0.2) and total score (257+36.8/300:p=0.1), whereas in residents there was statistically significant deference in Resection score (86.69+9.95/119+0.5:p= < 0.001), Bleeding control score(57+10.2/69+0.7:p=0.001),Safety Score(48.46+14.0/77.69+4.3:p= < 0.001) and total score (196+39.0/298+3.65:p= < 0.001).

In comparing 1st attempts (Faculty vs Residents), there was statistically significant difference in resection score (112+8.6/86.69+9.95: p= < 0.000), bleeding control score (70/57+10.2:p=0.001), safety score (70+14.14/48.46+14.0:p=0.01) and total score (257+36.81/196+39.0:p=0.01). Trainee’s achieved comparable skill’s scores vs faculty at the end of study (Total Scores. 298.0+3.6/300:p=0.3).

GRS scores of trainees also significantly improved (1st 12.0+2.97/5th 19.15+3.10:p= < 0.001).