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competence. Operating room time, total fluoroscopy time, stone-free rates, compli-
cation rates, instrument damage, and cost have all been used as surrogate outcomes
in the measurement of a URS learning curve [ 135 ]. As such, there is a documentable
improvement in the complication and success rates of URS with surgeon experience
[ 135 ]. Making sure residents are well trained upon graduation from residency, the
ACGME has placed a minimum number of 60 URS cases for graduating residents.
However, they also note “the minimum requirement for procedures does not sup-
plant the requirement that, upon a resident’s completion of the program, the pro-
gram director must verify that he or she has demonstrated sufficient competence to
enter practice without direct supervision” (http://www.acgme.org/portals/0/pfas-
sets/programresources/480-urology-case-log-info_.pdf). Consequently, teaching
programs and their trainees are starting to become objectively measured. The
Objective Structured Assessment of Technical Skills (OSATS), based on a 14-point
curriculum, has been designed to assess the necessary cognitive and psychomotor
skills of trainees, and it has indeed shown to correlate ureteroscopic performance
with experience [ 136 ].
As discussed previously, there has been a push to augment training programs
with simulators to potentially bypass the early error-prone learning curve of proce-
dures. URS is a particular procedure that has seen significant innovations in
Fig. 24.12 Robotic-
assisted ureteral
reimplantation model [ 83 ].
(a) Storage container 15 ×
11 × 3 inches
(approximately US $5);
large bag clip
(approximately US $3)
attached with Velcro
adhesive tape
(approximately US $4),
(b) alligator clips × 2
(approximately US $3)
(c) twine (approximately
US $5), (d) ureteral 6-F JJ
stent, (e). **The cost does
not include ureteral stent
and suture
W. Baas et al.