Hypospadias repair is an index pediatric urology procedure that requires trainee familiarity
with surgical loupes. A previous low-fidelity, 6-step curriculum was proposed that
deconstructed the most important steps of loupe surgery. We expanded on this curriculum
with an intermediate-fidelity silicone hypospadias model and designed an abbreviated
version of the 6-step curriculum to precede the hypospadias repair simulation.
To assess the validity of our prior, low-fidelity conceptual model using the metric
of improved performance on the intermediate-fidelity silicone hypospadias model.
A silicone model was first prototyped with the design software Solidworks™, and then
fabricated using a cast made of a mixture of silicone rubbers designed to function
like skin and soft tissue (Mold Star 20T, Dragon skin FX-pro and Slacker). Casts were
used to create the penile shaft model and the dorsal hooded foreskin model. The urethral
plate was cast separately on a flat surface. The model was then assembled by hand.
The model used for simulation included the penile shaft and urethral plate, while
the dorsal-hooded foreskin was prepared to simulate the penile anatomy separately.
Trainees were then divided into two groups. Group 1 practiced the low-fidelity curriculum
(3 tasks) and then performed dissection of the urethral plate and suturing using the
intermediate-fidelity hypospadias model. Group 2 practiced hypospadias repair prior
to the low-fidelity curriculum. Both groups’ models were scored by 3 blinded urologists.
Trainees were then asked to complete a post simulation satisfaction survey. Data analysis
was performed in IBM SPSS Statistics for Macintosh (Version 28.0 Armonk, NY: IBM Corp).
Twenty-two candidates across Wisconsin, USA, and Dublin, Ireland participated in the
study. This included 7 s-year residents, 9 third-year residents, 2 fourth-year residents,
and 3 fifth-year residents. Both Groups 1 and 2 had a similar distribution of trainees
(p = 0.60). Group 1 outperformed group 2 in all tasks (p < 0.05, Table 1). Trainees
reported that the platform was very useful (91%).
Our curriculum showed improvement in trainee ability and comfort to perform hypospadias
repair. Advantages of such a simulated curriculum include improving current resident
training in microsurgery, improving surgical ergonomics for trainees prior to real-time
experience, and decreasing the learning curve for trainees pursuing pediatric urology.
An intermediate-fidelity hypospadias platform externally validates the conceptual
model implemented in the low-fidelity loupes curriculum. This appears to lead to improvement
in loupe surgical skills regardless of trainee level.