29The methods for achieving affective objectives within a curriculum require expo-
sure to knowledge, experiences, or the views of respected experts and faculty that
either contradict undesired or confirm desired attitudes. Selection of well-respected,
reliable faculty with a commitment to clinical excellence and constructive educa-
tional participation in a training program are instrumental to the success of affective
learning for urology trainees. Trainee exposure to affective objectives can be through
readings, discussion, and clinical experiences. Facilitation of openness, introspec-
tion, and reflection are key to these encounters and usually need to be overseen by
faculty to ensure a constructive process. All personnel and faculty with whom resi-
dents train are role models, and it is critical that these educational encounters are
consistent and reflect the caring and professional attitudes we desire in our next
generation of urologists. It is important that senior and chief residents recognize that
they serve as important role models for medical students and junior residents and as
such are very visible attitudinal instructors within training programs.
Motor and psychomotor skill objectives are a salient aspect of any surgical train-
ing program. Kern and colleagues have similarly developed a model that integrates
the six-step principles of curriculum development and simulation design that is
applicable across surgical specialties [ 10 ]. Its use could lead to high-quality simula-
tion courses that integrate efficiently into an overall curriculum.
A variety of educational strategies can be used to teach the critical skill sets to
multiple specialties in surgery and medicine. Methods for achieving psychomotor
learning objectives include supervised clinical experiences, simulated learning and
practice sessions with artificial materials models, animal models, cadaveric models,
standardized patients, and role-playing sessions. In addition, audio and visual
reviews, such as video libraries for specific surgical procedures and techniques
available within the AUA Core Curriculum, can be very helpful for trainees devel-
oping their surgical skills and judgments. These help them identify good surgical
techniques and performance proficiency levels when developed by reliable expert
educators and have been shown to improve resident trainee operative task perfor-
mance [ 11 ].
Research has shown that repetitive distribution of motor skills learning is supe-
rior to single concentrated skills learning [ 12 , 13 ]. The development of neural pat-
terns for long-term establishment of motor skills is facilitated by the cycle of
repetitive simulated practice to prescribed proficiency criteria [ 14 ]. Introduction to
skills learning is usually done through didactic presentations, demonstrations, and
discussion. On this framework of skills knowledge, it is then important to build
opportunities to practice the skills, experience errors or complications including
management of these undesired outcomes, and then reflect upon the entire learning
process and determine how to better address the skill practice at a subsequent learn-
ing session. Constructive, facilitative feedback from an expert to the learner is very
valuable in this process and is best administered during or immediately following
the learning experience. In this way the trainee can repeat the motor skill learning
cycle until they have mastered the skill to the predetermined proficiency level. This
is best accomplished in a safe and supportive learning environment. Structured sim-
ulation is an ideal platform for this type of learning because it allows for repetitive
practice of skills, to a prescribed and objectively measurable proficiency level, away
from the patient. Immediate feedback and re-practice with learned information from
3 Curriculum Development