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Validation of the endoscopic stone treatment step 1 (EST-s1): a novel EAU training and assessment tool for basic endoscopic stone treatment skills-a collaborative work by ESU, ESUT and EULIS

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ESU Training Group, Domenico Veneziano, Achilles Ploumidis, Silvia Proietti, Theodoros Tokas, Guido Kamphuis, Giovanni Tripepi, Ben Van Cleynenbreugel, Ali Gozen, Alberto Breda, Joan Palou, Kemal Sarica, Evangelos Liatsikos, Kamran Ahmed, Bhaskar K Somani

Original languageEnglish
Pages (from-to)193-205
Number of pages13
JournalWorld Journal of Urology
Issue number1
Early online date27 Mar 2019
Accepted/In press18 Mar 2019
E-pub ahead of print27 Mar 2019

King's Authors


INTRODUCTION: The endoscopic stone treatment step 1 (EST s1) protocol has been developed after 2 years of collaborative work between different European Association of Urology (EAU) sections.

OBJECTIVES: In this study, we added construct validity evidence to the EST s1 curriculum.

MATERIALS AND METHODS: The EST-s1 curriculum includes four standardized tasks: flexible cystoscopy, rigid cystoscopy, semi-rigid URS and flexible URS. Validation was performed during the annual 2016 EUREP meeting in Prague. 124 participants provided information on their endoscopic logbook and carried out these 4 tasks during a DVD recorded session. Recordings were anonymized and blindly assessed independently by five proctors. Inter-rater reliability was checked on a sample of five videos by the calculation of intra-class correlation coefficient. Task-specific clinical background of participants was correlated with their personal performance on the simulator. Breakpoint analysis was used to define the minimum number of performed cases, to be considered "proficient". "Proficient" and "Non-proficient" groups were compared for construct validity assessment. Likert scale-based questionnaires were used to test content and to comment on when the EST-s1 exams should be undertaken within the residency program.

RESULTS: 124 participants (105 final-year residents and 19 faculty members) took part in this study. The breakpoint analysis showed a significant change in performance curve at 36, 41, 67 and 206 s, respectively, corresponding to 30, 60, 25 and 120 clinical cases for each of the 4 tasks. EST-s1 was scored as a valid training tool, correctly representing the procedures performed in each task. Experts felt that this curriculum is best used during the third year of residency training.

CONCLUSION: Our validation study successfully demonstrated correlation between clinical expertise and EST-s1 tasks, adding construct validity evidence to it. Our work also demonstrates the successful collaboration established within various EAU sections.

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