UF Health Spearheading Simulator-Based Mastery Training for Prostate Biopsies
Traditional prostate biopsies don’t have the greatest track record when it comes to catching cancers, as various studies report a false negative rate ranging from 21-47%. That’s why the urologists at the University of Florida are pioneering a simulation-based mastery training in prostate biopsy with the goal of improving those statistics.
The UF College of Medicine Department of Urology is offering one-of-a-kind mastery training in prostate biopsy (PBx) using a prostate biopsy simulator. The training is unlike standard, time-based training as mastery is based on attaining a quantitative threshold for accuracy of placing prostate biopsy cores, with no limit on the time taken to reach mastery. Mastery is defined as an average deviation of 5 mm or less for the shortest distance between the center of each actual biopsy core and its intended location. For the past four years, this mastery-based simulation training has been part of an established program used to train all UF’s incoming urology residents.
Thomas Stringer, MD, is the instructor for the simulation training for transrectal prostate biopsy, while Wayne Brisbane, MD, is starting training in transperineal prostate biopsy. Both mastery-based courses use the PBx simulator developed at the UF Center for Safety, Simulation & Advanced Learning Technologies, or CSSALT, a well-recognized leader in mixed reality procedural simulators, led by Samsun Lampotang, PhD, FSSH, FAIMBE.
During the simulation, as in actual patients, a transrectal ultrasound (TRUS) probe is inserted in the rectum to image the prostate. A biopsy needle is inserted into the prostate, either transrectally or transperineally, and directed under TRUS guidance to the desired location in the prostate where the biopsy is to be taken. A real-time 3D visualization helps novices understand the spatial relationships between the prostate and locations within the prostate, the TRUS probe and biopsy needle, and the effect of their technique on the accuracy of biopsy core placement.
Once the biopsy needle is believed to be in the desired location, the clinician fires the biopsy needle to grab a small sample of the prostate. Generally, 12 biopsy samples are taken in a prescribed pattern. Inaccuracy occurs when the actual biopsy core is taken too far from the desired sampling location.
The UF PBx simulator, as well as a pitch-neutral technique developed with the UF PBx simulator that is taught during the mastery-based training, have been published as a peer-reviewed paper in the British Journal of Urology International.