Development Methodology of the Novel Endoscopic Stone Treatment Step 1 Training/Assessment Curriculum: An International Collaborative Work by European Association of Urology Sections

Background: Simulation-based technical skill assessment is a core topic of debate, especially in high-risk environments. After the introduction of the E-BLUS (European Basic Laparoscopic Urological Skills) exam for basic laparoscopy, no more technical training/assessment urological protocols have been developed in Europe. Objective: We describe the methodology used in the development of the novel Endoscopic Stone Treatment step 1 (EST s1) assessment curriculum. Materials and Methods: The full life cycle curriculum development'' template was followed for curriculum development. A cognitive task analysis was run to define the most important steps and details of retrograde intrarenal surgery, in accordance with European Association of Urology (EAU) Urolithiasis guidelines. Training tasks were created between April 2015 and September 2015. Tasks and metrics were further analyzed by a consensus meeting with the European Section of Urolithiasis (EULIS) board in February 2016. A review, aimed to study available simulators and their accordance with task requirements, was subsequently run in London in March 2016. After initial feedback and further tests, content validity of this protocol was achieved during European Urology Residents Education Programme (EUREP) 2016. Results: The EST s1 curriculum development, took 23 months. Seventy-two participants tested the five preliminary tasks during EUREP 2015, with sessions of 45 minutes each. Likert-scale questionnaires were filled out to score the quality of training. The protocol was modified accordingly and 25 participants tested the four tasks during the hands-on training sessions of the European Section of Uro-Technology (ESUT) 2016 congress. One hundred thirty-four participants finally participated in the validation study in EUREP 2016. During the same event, 10 experts confirmed content validity by filling out a Likert-scale questionnaire. Conclusion: We described a reliable and replicable methodology that can be followed to develop training/assessment protocols for surgical procedures. The expert consensus meetings, strict adherence to guidelines, and updated literature search toward an Endourology curriculum allowed correct training and assessment protocol development. It is the first step toward standardized simulation training in Endourology with a potential for worldwide adoption.