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OBJECTIVE: Simulation-based training is well recognized in the transforming field of urological surgery; however, integration into the curriculum is often unstructured. Development of simulation-based curricula should follow a stepwise approach starting with a needs assessment. This study aimed to identify technical procedures in urology that should be included in a simulation-based curriculum for residency training.MATERIALS AND METHODS: A national needs assessment was performed using the Delphi method involving 56 experts with significant roles in the education of urologists. Round 1 identified technical procedures that newly qualified urologists should perform. Round 2 included a survey using an established needs assessment formula to explore: the frequency of procedures; the number of physicians who should be able to perform the procedure; the risk and/or discomfort to patients when a procedure is performed by an inexperienced physician; and the feasibility of simulation training. Round 3 involved elimination and reranking of procedures according to priority.RESULTS: The response rates for the three Delphi rounds were 70%, 55% and 67%, respectively. The 34 procedures identified in Round 1 were reduced to a final prioritized list of 18 technical procedures for simulation-based training. The five procedures that reached the highest prioritization were cystoscopy, transrectal ultrasound-guided biopsy of the prostate, placement of ureteral stent, insertion of urethral and suprapubic catheter, and transurethral resection of the bladder.CONCLUSION: The prioritized list of technical procedures in urology that were identified as highly suitable for simulation can be used as an aid in the planning and development of simulation-based training programs.

PURPOSE: Increased awareness of patient safety, advances in surgical technology and reduced working times have led to the adoption of simulation enhanced training. However, the simulators available need to be scientifically evaluated before integration into curricula. We identify the currently available training models for urological surgery, their status of validation and the evidence behind each model.MATERIALS AND METHODS: MEDLINE®, Embase® and the Cochrane Library databases were searched for English language articles published between 1990 and 2015 describing urological simulators and/or validation studies of these models. All studies were assessed for level of evidence, and each model was subsequently awarded a level of recommendation using a modified Oxford Centre for Evidence-Based Medicine classification, adapted for education by the European Association of Endoscopic Surgeons.RESULTS: A total of 91 validation studies were identified pertaining to training models in endourology (63), laparoscopic surgery (17), robot-assisted surgery (8) and open urological surgery (6), with a total of 55 models. Of the included studies 6 were classified Level 1b, 9 Level 2a, 39 Level 2b and 19 Level 2c. Of all the training models the URO Mentor™ was the only one to receive a level of recommendation of 1.CONCLUSIONS: UroSimulation is a growing field and increasing numbers of models are being produced. However, there are still too few validation studies with a high level of evidence demonstrating the transferability of skills. Nevertheless, efforts should be made to use the currently available models in curriculum based training programs.