Training Role of Active Mentoring During Flexible Ureteroscopy Training Raguram Ganesamoni, M.Ch., Shashikant Mishra, D.N.B., Akhilesh Kumar, MVSc, Arvind Ganpule, D.N.B., Jigish Vyas, D.N.B., Pradeep Ganatra, MBBS, Ravindra B. Sabnis, M.Ch., and Mahesh R. Desai, FRCS Abstract Purpose: To evaluate the outcome of flexible ureteroscopy training with or without an active mentor. Materials and Methods: Thirty-six flexible ureteroscopy naive practicing urologists and urology residents, after an initial introductory refreshment course, underwent training under a mentor for 15 minutes each in a high- fidelity nonvirtual reality Endo-Urologie-Modell (Karl Storz). The trainees were then randomized into two equal groups for training: One under a mentor and the other without. These two groups completed the training for 2 hours. Global rating scale (GRS) for the performance of flexible ureteroscopy was measured by a blinded expert at the beginning and end of the training. A specific task completion time (TCT) was noted at the end of the training. The trainees noted their own global rating scale at the end of the training. Results: The GRS by the expert at the end of the training was significantly higher in the mentor group. TCT was significantly lower in the mentor group. TCT correlated well with the GRS as measured by the expert rather than the trainee. Conclusion: Mentorship during flexible ureteroscopy training results in higher GRS and lower TCT at the end of the training. Self-assessment GRS by trainee does not correlate well with the skills acquired. Introduction T he average size of renal stones that are managed by urologists is decreasing, and there is a simultaneous increase in the size of stones that can be tackled using flexible ureteroscopy. In this background, with better availability of flexible ureteroscopes and high cost of maintenance, adequate training in flexible ureteroscopy has become important for both urology residents and practicing urologists. It has been shown that training in flexible ureteroscopy using either virtual reality or high-fidelity nonvirtual real- ity models improves performance. 1 Although active men- toring during the performance of initial procedures in surgery has been shown to decrease the learning curve, 2 the same has not been studied in training models. We studied the influence of active mentoring during flexible uretero- scopy. Materials and Methods Subjects The participants included were urology residents and board-certified urologists with the majority having previous experience with semirigid ureteroscopy. Those who had previous experience with flexible ureteroscopy were excluded. A total of 36 participants took part in the training. Model The high-fidelity nonvirtual reality bench model used for the study was Endo-Urologie-Modell (Karl Storz TM ) (Fig. 1). It consists of a mannequin of the male genitourinary tract through which standard instruments may be passed. The trainees practiced with a real flexible ureteroscope (Flex-X2, Karl Storz TM ), which they will be using subsequently in their operating rooms. The trainer allows the user to simulate several endourologic techniques including visualization of the entire urinary tract, guidewire insertion, placement of stent, lithotripsy. and stone retrieval. Study design All the participants were given didactic lectures and a video session about flexible ureteroscopy by an expert. After these, they were given hands-on training in high-fidelity nonvirtual reality Endo-Urologie-Modell for 15 minutes by a flexible ureteroscopy expert (mentor). Then they were randomized into two equal groups—one under the mentor Department of Urology, Muljibhai Patel Urological Hospital, Nadaid, Gujarat, India. JOURNAL OF ENDOUROLOGY Volume 26, Number 10, October 2012 ª Mary Ann Liebert, Inc. Pp. 1346–1349 DOI: 10.1089/end.2012.0258 1346