Urology simulation boot camp: A perspective from non-UK delegates | Actas Urológicas Españolas (English Edition)

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Sundelin, J.D.C. Silva, A.V. Daele, V. Savopoulos, G.M. Pirola, S. Ranasinghe, B.V. Cleynenbreugel, C.S. Biyani, M. Kailavasan" "autores" => array:9 [ 0 => array:3 [ "nombre" => "M.O." "apellidos" => "Sundelin" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "J.D.C." "apellidos" => "Silva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A.V." "apellidos" => "Daele" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "V." "apellidos" => "Savopoulos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "G.M." "apellidos" => "Pirola" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "S." "apellidos" => "Ranasinghe" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] ] ] 6 => array:3 [ "nombre" => "B.V." "apellidos" => "Cleynenbreugel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 7 => array:4 [ "nombre" => "C.S." "apellidos" => "Biyani" "email" => array:1 [ 0 => "shekharbiyani@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "g" "identificador" => "aff0035" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 8 => array:3 [ "nombre" => "M." "apellidos" => "Kailavasan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "h" "identificador" => "aff0040" ] ] ] ] "afiliaciones" => array:8 [ 0 => array:3 [ "entidad" => "Departamento de Urología, Hospital Universitario de Aarhus, Aarhus, Denmark" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Universitario de Motol, Praga, Czech Republic" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Urología, Hospital Universitario UZ Leuven, Lovaina, Belgium" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Hospital Universitario de Lusaka, Lusaka, Zambia" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Departamento de Urología, Usl Toscana Sud Est, Hospital San Donato, Italy" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Universidad de Queensland, Brisbane, Australia" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Hospital Universitario St. James's, Leeds, UK" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Leicester General Hospital, Leicester, UK" "etiqueta" => "h" "identificador" => "aff0040" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Boot camp de simulación en urología: perspectiva de los delegados no británicos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1255 "Ancho" => 1750 "Tamanyo" => 233200 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "(A) Module 1 (simulation of a boari flap), (B) Module 2 (Testicular fixation), (C) Module 3 Basic laparoscopy (clipping the renal pedicle), (D) Module 4 (Transurethral resection of the prostate and bladder)." ] ] ] "textoCompleto" => "IntroductionSimulation-based training is an ever-increasing important aspect of surgical training. Surgery as an experience dependent craft specialty is affected more than other medicine disciplines. In order, to maximize all training opportunities in the clinical settings, having pre-developed core skills can facilitate this. One approach to simulation-based education is the “boot camp concept” based on the military style boot camp training (intense, focused and hands on). Commencing training with a focused boot camp covering technical and non-technical skills can be a highly effective method for reducing anxiety and stress.<a class="elsevierStyleCrossRefs" href="#bib0005">1–3</a> A “Total Simulation Programme”, is a concept applied in the 5-day Urology Simulation Boot Camp (Leeds, United Kingdom) offering a combination of non-technical and technical skills, and considered as a mandatory course for all trainees beginning urology specialty training in the U.K.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> A lack of surgical confidence in European urology trainees was reported and such a standardized course would help residents across the Europe.<a class="elsevierStyleCrossRefs" href="#bib0025">5–7</a> In Europe, residency programs are very heterogeneous and suffer from “simulation training poverty”; they face the lack of a standardized curriculum even inside the same country.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>Differences in cultures and experiences may lead to different surgical values and training expectations; therefore, it can be a daunting task for a non-UK urology trainee to attend a course based on the UK urology curriculum. Difficulties may arise around the informal expressions used by trainers, co-participants and actors and jargon and abbreviations used in the intense simulation course setting.The objective of this study is to share experiences of non-UK trainees attending the Urology Simulation Bootcamp course (USBC) and compare their performance to U.K trainees.Materials and methodsThe Urology Simulation Boot Camp was started in 2015 in Leeds,<a class="elsevierStyleCrossRef" href="#bib0040">8</a> UK. A double-group cohort retrospective study was performed on attitude, performance and learning experience opportunities of the non-UK trainees that participated in the 2017 and 2018 Urology Simulation Boot Camp using a mixture of both quantitative and qualitative feedback.Course descriptionPrior to the start of the USBC, all trainees were enrolled on an online educational platform and had to complete a pre-course theoretical Multiple-Choice Questions (MCQs)-based assessment, as well as an operative experience questionnaire, designed to assess the level of confidence in performing basic urological procedures. According to their experience, participants were divided in groups of six trainees and completed a total of eight half-day modules. Written informed consent was obtained from all participants. Each module was led by one or two consultant leads and a total of over seventy faculty members, allowing one-on-one training.Course curriculum and deliveryThe course curriculum included 8 modules (Supplementary file 1) and a total of 30h of technical and 10h of non-technical skills training (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>):<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">1.Bowel Anastomosis, Stoma Formation, Ureteric Bladder Re-implantation.</li><li class="elsevierStyleListItem" id="lsti0010">2.Scrotal Examination, Testicular Fixation, Hydrocele, Troubleshooting with Catheterisation, Penile Fracture, Priapism.</li><li class="elsevierStyleListItem" id="lsti0015">3.Basic Laparoscopic Skills, Access, Lap Trainer Box, European basic laparoscopic urological skills (E-BLUS) Exercises, Harmonic, Basic Robotic Skills.</li><li class="elsevierStyleListItem" id="lsti0020">4.Transurethral resection of the prostate (TURP), Transurethral resection of the bladder tumor (TURBT), Bladder Washout, Instruments; Resectoscope/Urethrotome.</li><li class="elsevierStyleListItem" id="lsti0025">5.Emergency Scenarios.</li><li class="elsevierStyleListItem" id="lsti0030">6.Botox, Urodynamics, Urethral Bulking Simulation, Female Pelvic Examination.</li><li class="elsevierStyleListItem" id="lsti0035">7.Non-Technical Skills (Simulated Wardround).</li><li class="elsevierStyleListItem" id="lsti0040">8.Ureteroscopy (URS)/Accessories, Cystoscopy, Stenting, Instruments; Cystoscopy.</li></ul><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>AssessmentAfter completion of the course, trainees were provided with a “Trainee Summary Sheet”. This included pre and post-course MCQ score, Scores Non-technical modules and recommendations and baseline and assessment scores for technical skills. In addition, competency progression was outlined with strength and areas of improvement.A survey was conducted 12 months after the course among overseas delegates (Supplementary file 2). The objective was to assess usefulness of technical and non-technical skills acquired during the boot camp. The survey consisted of 10 questions. The first 6 questions provided a degree of opinion of both technical and non-technical skills using a 5-pont Likert scale after the course. The remaining four questions required free-text entries with open questions. The questionnaire was emailed to all overseas participants and a second email was done to non-responders after 6 weeks.Statistical analysisData was statistically analyzed using IBM SPSS Statistics Version 25. The Independent T-test was used to test differences in mean MCQ scores at baseline and final assessment. The Kruskal–Wallis test was applied to assess differences in assessment scores of endourological procedures (e.g., transurethral resection of the prostate/urethrotome/ureteroscopy) between UK and non-UK trainees. A Bonferonni correction was used to adjust for the number of hypothesis tested.Qualitative analysis of feedback forms from two years of the USBC followed an inductive process of becoming familiar with the data, generating initial codes, and then identifying common patterns or themes (content analysis). Patterns of commonality and divergent views were identified by the senior author (MK). When comments could not be placed into pre-determined categories then a further category was created.ResultsA total on 96 urology trainees attended the Urology Simulation Boot Camp in 2017 and 2018. Of these, twenty (21%) were international residents in training schemes (Australia, Belgium, Czech Republic, Denmark, Germany, Ireland, Italy, Zambia). Trainees from the UK scored higher in their pre-operative MCQ score as compared to trainees from the non-UK training system (mean difference=6.9, 95% CI: 0.2–14.). However, following completion of the USBC, both groups of trainees improved, with no difference in their objective outcomes (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Core urology knowledge and skillsSignificant findings were demonstrated between both groups at baseline at urethrotome knowledge, and assessment at urethrotome knowledge and performing TURP (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), where UK trainees scored slightly higher, although the median scores were not different. In addition, UK trainees performed better in the bowel anastomosis skill assessment by a mean difference of 7.057 (95% CI 0.682, 13.433)<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>E-BLUS laparoscopic skillNo significant difference was demonstrated between both groups in mean E-BLUS completion times for Task 2 – pattern cutting (U.K – 197s±86.2, International 204.5±63.2, p=0.684) and Task 4 – clip and cut (U.K – 329s±141.8, International – 357±140.9). Interestingly, non-UK participants were faster to completion in Task 2 and Task 4 at the beginning of the course. Both groups improved their completion times significantly at the end of the course by approximately 62s in Task 2, (p<0.003) and 160s in Task 4 (p<0.002). There was no significant difference in E-BLUS median scores between quality assessment of depth perception (3), bimanual dexterity (3), and efficiency (4) either at baseline or assessment between the two groups on the four hands-on-training (HOT) tasks (peg transfer, pattern cutting, single knot tying, and clip and cut).Nine participants answered the questionnaire (response rate=45%). All answered the six questions about the utility of simulation training using a five-point Likert scale (1 – strongly disagree to 5 – strongly agree). At least 7 of the 9 participants scored between 4 and 5 in response to each question (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). No participants scored <3 in any of the questions.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Qualitative feedbackPositive themes included the one to one training available for trainees (n=5) and the use of focussed feedback to improve on technical and non-technical skills in order to aid clinical practise (n=7). The most challenging aspect of the USBC regarded by international residents was the use of “UK consultation language and medical abbreviations” noted by four trainees (Supplementary file 3). Other negative themes included their feeling of inexperience compared to other residents or trainees (2/9), and the differences in technical approaches for management and operative procedures (1/9).DiscussionOur study demonstrates that USBC was an invaluable experience for overseas junior urology trainees with many important lessons and core values being gained as evidenced by our positive feedback. Despite differences in the culture and experiences between UK and international trainees, both sets of residents showed similar improvements in knowledge and technical skills at the end of the course. Specifically, non-UK trainees matched their UK colleagues in skills set at the end of the course. Many technical skills can be taught with different validated training modles.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> With the development of minimally-invasive techniques, an important part of the practical learning curve does not require direct exposure to patients for skill acquisition and surgical simulation has gained a fundamental role for teaching to less experienced fellows and residents.<a class="elsevierStyleCrossRefs" href="#bib0050">10,11</a> Likewise, virtual reality and technology advances have led to the development of high-fidelity simulators, and these can closely reproduce real-life scenarios therefore representing an important tool also for urologists facing a new type of technique before their clinical learning curve.<a class="elsevierStyleCrossRefs" href="#bib0060">12,13</a>The aim of the Urology Simulation Boot Camp is to directly expose trainees to all the existing relevant training simulators as per training requirements. A key feature highlighted by our overseas trainees in their feedback was the direct one to one supervision from an expert who can assess individual performance and focus on personal misunderstandings and weaknesses. In addition, each module provided pre-reading materials which allowed for further consolidation of knowledge to occur during the actual session. The combination of this multiple teaching methods and models, demonstrated a significant improvement in knowledge and technical skills during the course in both cohorts. Furthermore, international trainees acknowledged that in addition to focussing on technical skills, the improvement of non-technical skills was equally important in their clinical practise (88% felt that their non-technical skills have improved by the end of the course). These skills were focussed on during the emergency and ward round simulation, where trainees were evaluated for their ability to handle a stressful, difficult environment and respond accordingly in a realistic representation of a clinical situation. The lessons learned ranged from triaging multiple issues at once and the importance of clear communication to patients, colleagues and juniors. All overseas trainees agreed that the models used were excellent and a realistic representation of clinical practice.A previous paper regarding trainees’ outcomes at the second edition of the Urology Boot Camp has been recently published.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> Although, the technical skills learned over the week were immense, it was the non-technical skills gained directly and indirectly that were even more vital. Even observing other trainees participate was a tremendous learning experience, as lessons were learned on how stress can negatively impact performance. The de-brief sessions following each session with the actors, observers and consultants helped establish areas of weakness and was a great forum for open discussion, allowing further invaluable teaching. Some weaknesses of the USBC were that overseas residents found the expressions and nomenclature difficult to follow.The morning presentations served as an excellent warm-up to the day. Besides surgical and non-technical skills, the importance and impact of collegiality, pleasant working atmosphere, good work-life balance and mental health on learning was emphasized. The basic skills of coping with failure and expressing doubts and concerns should be incorporated in the daily training and guidance of young residents. Dealing with these topics in several talks on different days formed an important pillar of the urology simulation boot camp, adding great value to the ‘all round’ training for newly appointed urology trainees. Without a doubt, these so-called soft skills will gain a more important role in the training of residents, as awareness of the importance of quality of life grows. It is likely that soft skills will gain ground in future urology boot camps to come and one day even be taught in a separate module.As a potential next step, organizing actual discussions and working more interactively with topics like being bullied at work or second victim issues. The consideration should be given to more spontaneous discussion, fueled by input from the trainees. At least during certain parts of the day, the boot camp could leave room to cater to specific concerns the trainees might have.The importance of collegiality was reiterated to us throughout the whole week with many friendships made with urology trainees and urologists around the world all sharing similar stories of challenges faced. These lessons learned from discussions with urology trainees and consultants on how they approach difficult technical and non-technical situations were a definite highlight of the week and gave us more confidence heading into the training scheme in our own country. Many important lessons and values were gained from the Urology Simulation Boot Camp in Leeds ranging from particular technical skills to non-technical skills acquired directly and indirectly from Urologists and fellow Urology trainees during the week. As such, the Boot Camp was an invaluable experience that helps trainees to learn core lessons and values required to be a competent and safe urologist.Following the positive feedback (100% of international trainees enjoyed the boot camp and would recommend the course), A shorter version of the Urology Boot Camp has been delivered for the Year 1 urology residents in Portugal (2018, 2019) and Belgium (2019) in collaboration with the European School of Urology. Given these benefits and success, there is a good reason to consider a similar program for residents in Europe.LimitationsWithin the limitations of a retrospective double cohort study, we acknowledge that there is some missing data from trainees who failed to complete our survey at 12 months. Survey research in healthcare and education is an important tool to collect information about delivery, training methods and overall issues relating to the course. Our study managed to achieve a modest response rate of 45%, which is acceptable according to published studies.ConclusionsThe USBC was primarily aimed at training UK residents at the beginning of their urology speciality training, with the purpose of overseas trainees providing insight into how a similar course could be adapted internationally.FundingThe device and sponsorship for the urology boot camp was provided by Karl Storz, Cook Medical, Coloplast, Ethicon, Dantec, OKB Medical (Simbionix), MediPlus, Teleflex, European Pharma." "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres1445113" "titulo" => "Abstract" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Design, setting and participants" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Outcome measurements and statistical analysis" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Results and limitations" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1318534" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1445114" "titulo" => "Resumen" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "abst0035" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0040" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0045" "titulo" => "Diseño, marco y participantes" ] 3 => array:2 [ "identificador" => "abst0050" "titulo" => "Medición de resultados y análisis estadístico" ] 4 => array:2 [ "identificador" => "abst0055" "titulo" => "Resultados y limitaciones" ] 5 => array:2 [ "identificador" => "abst0060" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1318533" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Course description" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Course curriculum and delivery" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Assessment" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Core urology knowledge and skills" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "E-BLUS laparoscopic skill" ] ] ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Qualitative feedback" ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Limitations" ] 10 => array:2 [ "identificador" => "sec0065" "titulo" => "Conclusions" ] 11 => array:2 [ "identificador" => "sec0070" "titulo" => "Funding" ] 12 => array:2 [ "identificador" => "xack504604" "titulo" => "Acknowledgements" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-01-17" "fechaAceptado" => "2020-03-22" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1318534" "palabras" => array:4 [ 0 => "Medical simulation" 1 => "Urology training" 2 => "Boot camp" 3 => "Non-technical skills" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1318533" "palabras" => array:4 [ 0 => "Simulación médica" 1 => "Entrenamiento en urología" 2 => "Boot camp" 3 => "Habilidades no técnicas" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "BackgroundMedical simulation has become an integral part of modern-day surgical training. Despite its benefits, it is still not widely incorporated in the curriculum of trainees. The Urology Boot Camp (USBC) is an innovative 5-day course aimed at trainees entering the UK training scheme. Since its implementation, there's been increasing interest by non-UK trainees. ObjectiveTo assess the experiences of non-UK trainees in the USBC, both quantitatively and qualitatively, including skills progression analysis. Design, setting and participantsThis double-group cohort retrospective study included 20 delegates from non-UK countries and 76 trainees from UK who attended the USBC in 2017 and 2018. Trainees undertook pre- and post-course MCQs, pre-course operative experience questionnaires and a 12-month post-course survey on the usefulness of the skills acquired. Outcome measurements and statistical analysisDifferences in mean MCQ scores between UK and non-UK delegates at baseline and after the course were assessed by the independent T-test. Each core urology procedural skill was evaluated by an expert and graded according to a Likert scale (1–5). The Kruskal–Wallis test was used to assess the differences in the scores between both groups on endourological techniques. A Likert scale (1–5) was used to grade the participants’ answers to the post-course 12-month survey. Results and limitationsTrainees from UK scored significantly higher in the pre-course MCQ assessment, however after completion of the boot camp, no significant difference was noted. There were no differences between the groups at e-BLUS completion times, and both groups significantly improved their results. A 12-month post-course survey on the utility of training during the boot camp and qualitative evaluation of the course by overseas delegates was very positive. ConclusionsThe USBC is a valuable learning experience that leads to improvement of technical and soft skills of UK and non-UK trainees alike." "secciones" => array:6 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Design, setting and participants" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Outcome measurements and statistical analysis" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Results and limitations" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "AntecedentesLa simulación médica se ha convertido en una parte integral de la formación quirúrgica moderna. Pero a pesar de sus beneficios, todavía no ha sido ampliamente incorporada en la formación de los residentes. El Boot Camp de Simulación en Urología (BCSU) es un curso innovador de cinco días, dirigido a residentes que entran en el programa de formación del Reino Unido. Desde su implementación ha generado un creciente interés por parte de los residentes no británicos. ObjetivoEvaluar la experiencia de los residentes no británicos en el BCSU, tanto cuantitativa como cualitativamente, incluyendo un análisis de la evolución de sus habilidades. Diseño, marco y participantesEste estudio retrospectivo de doble cohorte incluyó a 20 delegados de países no británicos y 76 residentes del Reino Unido que asistieron al BCSU en 2017 y 2018. Los residentes contestaron preguntas tipo test (PTT) antes y después del curso, cuestionarios de experiencia quirúrgica previos al curso y una encuesta sobre la utilidad de los conocimientos adquiridos, 12 meses después del curso. Medición de resultados y análisis estadísticoLas diferencias en las puntuaciones medias de las PTT entre los delegados del Reino Unido y los no británicos, antes y después del curso, fueron evaluadas con una prueba de T independiente. Cada habilidad de procedimientos de urología básica fue evaluada por un experto y calificada de acuerdo con una escala de Likert (1-5). La prueba de Kruskal-Wallis se utilizó para evaluar las diferencias en las puntuaciones entre ambos grupos en las técnicas de endourología. Se utilizó una escala de Likert (1-5) para calificar las respuestas de los participantes a la encuesta realizada 12 meses después del curso. Resultados y limitacionesLos alumnos del Reino Unido obtuvieron una puntuación significativamente más alta en las PTT previas al curso; sin embargo, tras la finalización del entrenamiento, no se observó ninguna diferencia significativa. No hubo diferencias entre los grupos en los tiempos de finalización de las e-BLUS (Habilidades básicas en técnicas por laparoscopia en urología), y ambos grupos mejoraron significativamente sus resultados. Una encuesta realizada 12 meses después del curso sobre la utilidad del entrenamiento durante el campamento y la evaluación cualitativa del curso por parte de los delegados extranjeros fue muy positiva. ConclusionesEl BCSU es una experiencia valiosa de aprendizaje que conduce a una mejora de las habilidades técnicas y sociales de los residentes tanto del Reino Unido como de otros países." "secciones" => array:6 [ 0 => array:2 [ "identificador" => "abst0035" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0040" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0045" "titulo" => "Diseño, marco y participantes" ] 3 => array:2 [ "identificador" => "abst0050" "titulo" => "Medición de resultados y análisis estadístico" ] 4 => array:2 [ "identificador" => "abst0055" "titulo" => "Resultados y limitaciones" ] 5 => array:2 [ "identificador" => "abst0060" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Sundelin MO, Silva JD, Daele AV, Savopoulos V, Pirola GM, Ranasinghe S, et al. Boot camp de simulación en urología: perspectiva de los delegados no británicos. Actas Urol Esp. 2021;45:49–56." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0080" ] ] ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1255 "Ancho" => 1750 "Tamanyo" => 233200 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "(A) Module 1 (simulation of a boari flap), (B) Module 2 (Testicular fixation), (C) Module 3 Basic laparoscopy (clipping the renal pedicle), (D) Module 4 (Transurethral resection of the prostate and bladder)." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1098 "Ancho" => 1750 "Tamanyo" => 299754 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "(A) Module 5 (Emergency urology scenarios with a SimMan and an actor), (B) Module 6 Female urology (Botox training), (C) Module 7, Simulated wardround with actors and nursing staff, (D) Module 8, Ureteroscopy." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0040" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">UK trainee \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Non-UK trainee \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Number \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean duration of training (months) at all levels of training, months (±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.1±11.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21±7.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean on call urology experience at all levels of training, months (=/−SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.38±8.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.6±4.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean Pre-MCQ Score, % (±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59.1±9.62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.875±11.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.038 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean Post-MCQ Score, % (±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.28±13.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.52±12.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.707 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2485382.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographics and MCQ scores." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0045" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Competence (5-point Likert scale) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">International trainees</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">UK based trainees</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Significance (p value) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Median \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Range \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Median \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Range \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Knowledge</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Resectoscope</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Baseline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1–4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1–5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.076 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Assessment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3–5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3–5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.283 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urethrotome</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Baseline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1–4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1–5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.049 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Assessment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1–5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2–5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.036 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Technical</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TURP</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Baseline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2–4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2–5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.067 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Assessment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2–4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3–4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ureteroscopy</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Baseline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2–4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3–4.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.301 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Assessment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.5–4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2–5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.275 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Botox injection</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Assessment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3–5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2–5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.351 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2485383.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of knowledge and technical skills at baseline and after completion of the USBC between international and UK based trainees." ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0050" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Question</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="5" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Score</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Strongly disagree \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Disagree \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Neutral \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Agree \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Strongly agree \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">1 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">3 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">4 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">5 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">i \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Was the course relevant for you as a non-UK trainee? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (33.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (66.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ii \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">After returning to your own hospital, do you feel that your operating skills have improved? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (11.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (44.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (44.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">iii \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">After returning to your own hospital, do you feel that your non-technical skills have improved? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (11.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (55.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (33.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">iv \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Did the feedback match to your self-assessment? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (22.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (77.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">v \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Has your course feedback made a behavioral change in your clinical everyday life? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (11.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (55.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (33.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">vi \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I enjoyed the boot camp and would recommend it to a non-UK trainee \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (11.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (88.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2485384.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Itemized results from the simulation feedback form (n=9)." ] ] 5 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.doc" "ficheroTamanyo" => 32189 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of postgraduate medical education “boot camps” on clinical skills, knowledge, and confidence: a meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. 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"vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735786/0000004500000001/v1_202101060759/S2173578620301529/v1_202101060759/en/main.assets" "Apartado" => array:4 [ "identificador" => "6274" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735786/0000004500000001/v1_202101060759/S2173578620301529/v1_202101060759/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578620301529?idApp=UINPBA00004N"]

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Urology simulation boot camp: A perspective from non-UK delegates

Boot camp de simulación en urología: perspectiva de los delegados no británicos

M.O. Sundelina, J.D.C. Silvab, A.V. Daelec, V. Savopoulosd, G.M. Pirolae, S. Ranasinghef, B.V. Cleynenbreugelc, C.S. Biyanig,

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shekharbiyani@hotmail.com

Corresponding author.

, M. Kailavasanh

a Departamento de Urología, Hospital Universitario de Aarhus, Aarhus, Denmark

b Hospital Universitario de Motol, Praga, Czech Republic

c Departamento de Urología, Hospital Universitario UZ Leuven, Lovaina, Belgium

d Hospital Universitario de Lusaka, Lusaka, Zambia

e Departamento de Urología, Usl Toscana Sud Est, Hospital San Donato, Italy

f Universidad de Queensland, Brisbane, Australia

g Hospital Universitario St. James's, Leeds, UK

h Leicester General Hospital, Leicester, UK

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Simulation-based training is an ever-increasing important aspect of surgical training&#46; Surgery as an experience dependent craft specialty is affected more than other medicine disciplines&#46; In order&#44; to maximize all training opportunities in the clinical settings&#44; having pre-developed core skills can facilitate this&#46; One approach to simulation-based education is the &#8220;boot camp concept&#8221; based on the military style boot camp training &#40;intense&#44; focused and hands on&#41;&#46; Commencing training with a focused boot camp covering technical and non-technical skills can be a highly effective method for reducing anxiety and stress&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> A &#8220;Total Simulation Programme&#8221;&#44; is a concept applied in the 5-day Urology Simulation Boot Camp &#40;Leeds&#44; United Kingdom&#41; offering a combination of non-technical and technical skills&#44; and considered as a mandatory course for all trainees beginning urology specialty training in the U&#46;K&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> A lack of surgical confidence in European urology trainees was reported and such a standardized course would help residents across the Europe&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;7</span></a> In Europe&#44; residency programs are very heterogeneous and suffer from &#8220;simulation training poverty&#8221;&#59; they face the lack of a standardized curriculum even inside the same country&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Differences in cultures and experiences may lead to different surgical values and training expectations&#59; therefore&#44; it can be a daunting task for a non-UK urology trainee to attend a course based on the UK urology curriculum&#46; Difficulties may arise around the informal expressions used by trainers&#44; co-participants and actors and jargon and abbreviations used in the intense simulation course setting&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The objective of this study is to share experiences of non-UK trainees attending the Urology Simulation Bootcamp course &#40;USBC&#41; and compare their performance to U&#46;K trainees&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">The Urology Simulation Boot Camp was started in 2015 in Leeds&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> UK&#46; A double-group cohort retrospective study was performed on attitude&#44; performance and learning experience opportunities of the non-UK trainees that participated in the 2017 and 2018 Urology Simulation Boot Camp using a mixture of both quantitative and qualitative feedback&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Course description</span><p id="par0025" class="elsevierStylePara elsevierViewall">Prior to the start of the USBC&#44; all trainees were enrolled on an online educational platform and had to complete a pre-course theoretical Multiple-Choice Questions &#40;MCQs&#41;-based assessment&#44; as well as an operative experience questionnaire&#44; designed to assess the level of confidence in performing basic urological procedures&#46; According to their experience&#44; participants were divided in groups of six trainees and completed a total of eight half-day modules&#46; Written informed consent was obtained from all participants&#46; Each module was led by one or two consultant leads and a total of over seventy faculty members&#44; allowing one-on-one training&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Course curriculum and delivery</span><p id="par0030" class="elsevierStylePara elsevierViewall">The course curriculum included 8 modules &#40;Supplementary file 1&#41; and a total of 30<span class="elsevierStyleHsp" style=""></span>h of technical and 10<span class="elsevierStyleHsp" style=""></span>h of non-technical skills training &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Bowel Anastomosis&#44; Stoma Formation&#44; Ureteric Bladder Re-implantation&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Scrotal Examination&#44; Testicular Fixation&#44; Hydrocele&#44; Troubleshooting with Catheterisation&#44; Penile Fracture&#44; Priapism&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Basic Laparoscopic Skills&#44; Access&#44; Lap Trainer Box&#44; European basic laparoscopic urological skills &#40;E-BLUS&#41; Exercises&#44; Harmonic&#44; Basic Robotic Skills&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Transurethral resection of the prostate &#40;TURP&#41;&#44; Transurethral resection of the bladder tumor &#40;TURBT&#41;&#44; Bladder Washout&#44; Instruments&#59; Resectoscope&#47;Urethrotome&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5&#46;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Emergency Scenarios&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6&#46;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Botox&#44; Urodynamics&#44; Urethral Bulking Simulation&#44; Female Pelvic Examination&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7&#46;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Non-Technical Skills &#40;Simulated Wardround&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8&#46;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Ureteroscopy &#40;URS&#41;&#47;Accessories&#44; Cystoscopy&#44; Stenting&#44; Instruments&#59; Cystoscopy&#46;</p></li></ul></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Assessment</span><p id="par0075" class="elsevierStylePara elsevierViewall">After completion of the course&#44; trainees were provided with a &#8220;Trainee Summary Sheet&#8221;&#46; This included pre and post-course MCQ score&#44; Scores Non-technical modules and recommendations and baseline and assessment scores for technical skills&#46; In addition&#44; competency progression was outlined with strength and areas of improvement&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">A survey was conducted 12 months after the course among overseas delegates &#40;Supplementary file 2&#41;&#46; The objective was to assess usefulness of technical and non-technical skills acquired during the boot camp&#46; The survey consisted of 10 questions&#46; The first 6 questions provided a degree of opinion of both technical and non-technical skills using a 5-pont Likert scale after the course&#46; The remaining four questions required free-text entries with open questions&#46; The questionnaire was emailed to all overseas participants and a second email was done to non-responders after 6 weeks&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Statistical analysis</span><p id="par0085" class="elsevierStylePara elsevierViewall">Data was statistically analyzed using IBM SPSS Statistics Version 25&#46; The Independent <span class="elsevierStyleItalic">T</span>-test was used to test differences in mean MCQ scores at baseline and final assessment&#46; The Kruskal&#8211;Wallis test was applied to assess differences in assessment scores of endourological procedures &#40;e&#46;g&#46;&#44; transurethral resection of the prostate&#47;urethrotome&#47;ureteroscopy&#41; between UK and non-UK trainees&#46; A Bonferonni correction was used to adjust for the number of hypothesis tested&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Qualitative analysis of feedback forms from two years of the USBC followed an inductive process of becoming familiar with the data&#44; generating initial codes&#44; and then identifying common patterns or themes &#40;content analysis&#41;&#46; Patterns of commonality and divergent views were identified by the senior author &#40;MK&#41;&#46; When comments could not be placed into pre-determined categories then a further category was created&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><p id="par0095" class="elsevierStylePara elsevierViewall">A total on 96 urology trainees attended the Urology Simulation Boot Camp in 2017 and 2018&#46; Of these&#44; twenty &#40;21&#37;&#41; were international residents in training schemes &#40;Australia&#44; Belgium&#44; Czech Republic&#44; Denmark&#44; Germany&#44; Ireland&#44; Italy&#44; Zambia&#41;&#46; Trainees from the UK scored higher in their pre-operative MCQ score as compared to trainees from the non-UK training system &#40;mean difference<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#46;9&#44; 95&#37; CI&#58; 0&#46;2&#8211;14&#46;&#41;&#46; However&#44; following completion of the USBC&#44; both groups of trainees improved&#44; with no difference in their objective outcomes &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Core urology knowledge and skills</span><p id="par0100" class="elsevierStylePara elsevierViewall">Significant findings were demonstrated between both groups at baseline at urethrotome knowledge&#44; and assessment at urethrotome knowledge and performing TURP &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; where UK trainees scored slightly higher&#44; although the median scores were not different&#46; In addition&#44; UK trainees performed better in the bowel anastomosis skill assessment by a mean difference of 7&#46;057 &#40;95&#37; CI 0&#46;682&#44; 13&#46;433&#41;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">E-BLUS laparoscopic skill</span><p id="par0105" class="elsevierStylePara elsevierViewall">No significant difference was demonstrated between both groups in mean E-BLUS completion times for Task 2 &#8211; pattern cutting &#40;U&#46;K &#8211; 197s<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>86&#46;2&#44; International 204&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>63&#46;2&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;684&#41; and Task 4 &#8211; clip and cut &#40;U&#46;K &#8211; 329s<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>141&#46;8&#44; International &#8211; 357<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>140&#46;9&#41;&#46; Interestingly&#44; non-UK participants were faster to completion in Task 2 and Task 4 at the beginning of the course&#46; Both groups improved their completion times significantly at the end of the course by approximately 62<span class="elsevierStyleHsp" style=""></span>s in Task 2&#44; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41; and 160<span class="elsevierStyleHsp" style=""></span>s in Task 4 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#46; There was no significant difference in E-BLUS median scores between quality assessment of depth perception &#40;3&#41;&#44; bimanual dexterity &#40;3&#41;&#44; and efficiency &#40;4&#41; either at baseline or assessment between the two groups on the four hands-on-training &#40;HOT&#41; tasks &#40;peg transfer&#44; pattern cutting&#44; single knot tying&#44; and clip and cut&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Nine participants answered the questionnaire &#40;response rate<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>45&#37;&#41;&#46; All answered the six questions about the utility of simulation training using a five-point Likert scale &#40;1 &#8211; strongly disagree to 5 &#8211; strongly agree&#41;&#46; At least 7 of the 9 participants scored between 4 and 5 in response to each question &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; No participants scored &#60;3 in any of the questions&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Qualitative feedback</span><p id="par0115" class="elsevierStylePara elsevierViewall">Positive themes included the one to one training available for trainees &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41; and the use of focussed feedback to improve on technical and non-technical skills in order to aid clinical practise &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41;&#46; The most challenging aspect of the USBC regarded by international residents was the use of &#8220;UK consultation language and medical abbreviations&#8221; noted by four trainees &#40;Supplementary file 3&#41;&#46; Other negative themes included their feeling of inexperience compared to other residents or trainees &#40;2&#47;9&#41;&#44; and the differences in technical approaches for management and operative procedures &#40;1&#47;9&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">Our study demonstrates that USBC was an invaluable experience for overseas junior urology trainees with many important lessons and core values being gained as evidenced by our positive feedback&#46; Despite differences in the culture and experiences between UK and international trainees&#44; both sets of residents showed similar improvements in knowledge and technical skills at the end of the course&#46; Specifically&#44; non-UK trainees matched their UK colleagues in skills set at the end of the course&#46; Many technical skills can be taught with different validated training modles&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> With the development of minimally-invasive techniques&#44; an important part of the practical learning curve does not require direct exposure to patients for skill acquisition and surgical simulation has gained a fundamental role for teaching to less experienced fellows and residents&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a> Likewise&#44; virtual reality and technology advances have led to the development of high-fidelity simulators&#44; and these can closely reproduce real-life scenarios therefore representing an important tool also for urologists facing a new type of technique before their clinical learning curve&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The aim of the Urology Simulation Boot Camp is to directly expose trainees to all the existing relevant training simulators as per training requirements&#46; A key feature highlighted by our overseas trainees in their feedback was the direct one to one supervision from an expert who can assess individual performance and focus on personal misunderstandings and weaknesses&#46; In addition&#44; each module provided pre-reading materials which allowed for further consolidation of knowledge to occur during the actual session&#46; The combination of this multiple teaching methods and models&#44; demonstrated a significant improvement in knowledge and technical skills during the course in both cohorts&#46; Furthermore&#44; international trainees acknowledged that in addition to focussing on technical skills&#44; the improvement of non-technical skills was equally important in their clinical practise &#40;88&#37; felt that their non-technical skills have improved by the end of the course&#41;&#46; These skills were focussed on during the emergency and ward round simulation&#44; where trainees were evaluated for their ability to handle a stressful&#44; difficult environment and respond accordingly in a realistic representation of a clinical situation&#46; The lessons learned ranged from triaging multiple issues at once and the importance of clear communication to patients&#44; colleagues and juniors&#46; All overseas trainees agreed that the models used were excellent and a realistic representation of clinical practice&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">A previous paper regarding trainees&#8217; outcomes at the second edition of the Urology Boot Camp has been recently published&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Although&#44; the technical skills learned over the week were immense&#44; it was the non-technical skills gained directly and indirectly that were even more vital&#46; Even observing other trainees participate was a tremendous learning experience&#44; as lessons were learned on how stress can negatively impact performance&#46; The de-brief sessions following each session with the actors&#44; observers and consultants helped establish areas of weakness and was a great forum for open discussion&#44; allowing further invaluable teaching&#46; Some weaknesses of the USBC were that overseas residents found the expressions and nomenclature difficult to follow&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The morning presentations served as an excellent warm-up to the day&#46; Besides surgical and non-technical skills&#44; the importance and impact of collegiality&#44; pleasant working atmosphere&#44; good work-life balance and mental health on learning was emphasized&#46; The basic skills of coping with failure and expressing doubts and concerns should be incorporated in the daily training and guidance of young residents&#46; Dealing with these topics in several talks on different days formed an important pillar of the urology simulation boot camp&#44; adding great value to the &#8216;all round&#8217; training for newly appointed urology trainees&#46; Without a doubt&#44; these so-called soft skills will gain a more important role in the training of residents&#44; as awareness of the importance of quality of life grows&#46; It is likely that soft skills will gain ground in future urology boot camps to come and one day even be taught in a separate module&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">As a potential next step&#44; organizing actual discussions and working more interactively with topics like being bullied at work or second victim issues&#46; The consideration should be given to more spontaneous discussion&#44; fueled by input from the trainees&#46; At least during certain parts of the day&#44; the boot camp could leave room to cater to specific concerns the trainees might have&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The importance of collegiality was reiterated to us throughout the whole week with many friendships made with urology trainees and urologists around the world all sharing similar stories of challenges faced&#46; These lessons learned from discussions with urology trainees and consultants on how they approach difficult technical and non-technical situations were a definite highlight of the week and gave us more confidence heading into the training scheme in our own country&#46; Many important lessons and values were gained from the Urology Simulation Boot Camp in Leeds ranging from particular technical skills to non-technical skills acquired directly and indirectly from Urologists and fellow Urology trainees during the week&#46; As such&#44; the Boot Camp was an invaluable experience that helps trainees to learn core lessons and values required to be a competent and safe urologist&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Following the positive feedback &#40;100&#37; of international trainees enjoyed the boot camp and would recommend the course&#41;&#44; A shorter version of the Urology Boot Camp has been delivered for the Year 1 urology residents in Portugal &#40;2018&#44; 2019&#41; and Belgium &#40;2019&#41; in collaboration with the European School of Urology&#46; Given these benefits and success&#44; there is a good reason to consider a similar program for residents in Europe&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Limitations</span><p id="par0155" class="elsevierStylePara elsevierViewall">Within the limitations of a retrospective double cohort study&#44; we acknowledge that there is some missing data from trainees who failed to complete our survey at 12 months&#46; Survey research in healthcare and education is an important tool to collect information about delivery&#44; training methods and overall issues relating to the course&#46; Our study managed to achieve a modest response rate of 45&#37;&#44; which is acceptable according to published studies&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conclusions</span><p id="par0160" class="elsevierStylePara elsevierViewall">The USBC was primarily aimed at training UK residents at the beginning of their urology speciality training&#44; with the purpose of overseas trainees providing insight into how a similar course could be adapted internationally&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Funding</span><p id="par0165" class="elsevierStylePara elsevierViewall">The device and sponsorship for the urology boot camp was provided by <span class="elsevierStyleGrantSponsor" id="gs0005">Karl Storz</span>&#44; <span class="elsevierStyleGrantSponsor" id="gs0010">Cook Medical</span>&#44; <span class="elsevierStyleGrantSponsor" id="gs0015">Coloplast</span>&#44; <span class="elsevierStyleGrantSponsor" id="gs0020">Ethicon</span>&#44; <span class="elsevierStyleGrantSponsor" id="gs0025">Dantec</span>&#44; <span class="elsevierStyleGrantSponsor" id="gs0030">OKB Medical &#40;Simbionix&#41;</span>&#44; <span class="elsevierStyleGrantSponsor" id="gs0035">MediPlus</span>&#44; <span class="elsevierStyleGrantSponsor" id="gs0040">Teleflex</span>&#44; <span class="elsevierStyleGrantSponsor" id="gs0045">European Pharma</span>&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Medical simulation has become an integral part of modern-day surgical training&#46; Despite its benefits&#44; it is still not widely incorporated in the curriculum of trainees&#46; The Urology Boot Camp &#40;USBC&#41; is an innovative 5-day course aimed at trainees entering the UK training scheme&#46; Since its implementation&#44; there&#39;s been increasing interest by non-UK trainees&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To assess the experiences of non-UK trainees in the USBC&#44; both quantitatively and qualitatively&#44; including skills progression analysis&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Design&#44; setting and participants</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">This double-group cohort retrospective study included 20 delegates from non-UK countries and 76 trainees from UK who attended the USBC in 2017 and 2018&#46; Trainees undertook pre- and post-course MCQs&#44; pre-course operative experience questionnaires and a 12-month post-course survey on the usefulness of the skills acquired&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Outcome measurements and statistical analysis</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Differences in mean MCQ scores between UK and non-UK delegates at baseline and after the course were assessed by the independent <span class="elsevierStyleItalic">T</span>-test&#46; Each core urology procedural skill was evaluated by an expert and graded according to a Likert scale &#40;1&#8211;5&#41;&#46; The Kruskal&#8211;Wallis test was used to assess the differences in the scores between both groups on endourological techniques&#46; A Likert scale &#40;1&#8211;5&#41; was used to grade the participants&#8217; answers to the post-course 12-month survey&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Results and limitations</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Trainees from UK scored significantly higher in the pre-course MCQ assessment&#44; however after completion of the boot camp&#44; no significant difference was noted&#46; There were no differences between the groups at e-BLUS completion times&#44; and both groups significantly improved their results&#46; A 12-month post-course survey on the utility of training during the boot camp and qualitative evaluation of the course by overseas delegates was very positive&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The USBC is a valuable learning experience that leads to improvement of technical and soft skills of UK and non-UK trainees alike&#46;</p></span>"
        "secciones" => array:6 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objective"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Design&#44; setting and participants"
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            "identificador" => "abst0020"
            "titulo" => "Outcome measurements and statistical analysis"
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            "identificador" => "abst0025"
            "titulo" => "Results and limitations"
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            "titulo" => "Conclusions"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Antecedentes</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">La simulaci&#243;n m&#233;dica se ha convertido en una parte integral de la formaci&#243;n quir&#250;rgica moderna&#46; Pero a pesar de sus beneficios&#44; todav&#237;a no ha sido ampliamente incorporada en la formaci&#243;n de los residentes&#46; El <span class="elsevierStyleItalic">Boot Camp</span> de Simulaci&#243;n en Urolog&#237;a &#40;BCSU&#41; es un curso innovador de cinco d&#237;as&#44; dirigido a residentes que entran en el programa de formaci&#243;n del Reino Unido&#46; Desde su implementaci&#243;n ha generado un creciente inter&#233;s por parte de los residentes no brit&#225;nicos&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Objetivo</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Evaluar la experiencia de los residentes no brit&#225;nicos en el BCSU&#44; tanto cuantitativa como cualitativamente&#44; incluyendo un an&#225;lisis de la evoluci&#243;n de sus habilidades&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Dise&#241;o&#44; marco y participantes</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Este estudio retrospectivo de doble cohorte incluy&#243; a 20 delegados de pa&#237;ses no brit&#225;nicos y 76 residentes del Reino Unido que asistieron al BCSU en 2017 y 2018&#46; Los residentes contestaron preguntas tipo test &#40;PTT&#41; antes y despu&#233;s del curso&#44; cuestionarios de experiencia quir&#250;rgica previos al curso y una encuesta sobre la utilidad de los conocimientos adquiridos&#44; 12 meses despu&#233;s del curso&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Medici&#243;n de resultados y an&#225;lisis estad&#237;stico</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Las diferencias en las puntuaciones medias de las PTT entre los delegados del Reino Unido y los no brit&#225;nicos&#44; antes y despu&#233;s del curso&#44; fueron evaluadas con una prueba de T independiente&#46; Cada habilidad de procedimientos de urolog&#237;a b&#225;sica fue evaluada por un experto y calificada de acuerdo con una escala de Likert &#40;1-5&#41;&#46; La prueba de Kruskal-Wallis se utiliz&#243; para evaluar las diferencias en las puntuaciones entre ambos grupos en las t&#233;cnicas de endourolog&#237;a&#46; Se utiliz&#243; una escala de Likert &#40;1-5&#41; para calificar las respuestas de los participantes a la encuesta realizada 12 meses despu&#233;s del curso&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Resultados y limitaciones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Los alumnos del Reino Unido obtuvieron una puntuaci&#243;n significativamente m&#225;s alta en las PTT previas al curso&#59; sin embargo&#44; tras la finalizaci&#243;n del entrenamiento&#44; no se observ&#243; ninguna diferencia significativa&#46; No hubo diferencias entre los grupos en los tiempos de finalizaci&#243;n de las e-BLUS &#40;Habilidades b&#225;sicas en t&#233;cnicas por laparoscopia en urolog&#237;a&#41;&#44; y ambos grupos mejoraron significativamente sus resultados&#46; Una encuesta realizada 12 meses despu&#233;s del curso sobre la utilidad del entrenamiento durante el campamento y la evaluaci&#243;n cualitativa del curso por parte de los delegados extranjeros fue muy positiva&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conclusiones</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">El BCSU es una experiencia valiosa de aprendizaje que conduce a una mejora de las habilidades t&#233;cnicas y sociales de los residentes tanto del Reino Unido como de otros pa&#237;ses&#46;</p></span>"
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            "identificador" => "abst0035"
            "titulo" => "Antecedentes"
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            "identificador" => "abst0040"
            "titulo" => "Objetivo"
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          2 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Dise&#241;o&#44; marco y participantes"
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          3 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Medici&#243;n de resultados y an&#225;lisis estad&#237;stico"
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          4 => array:2 [
            "identificador" => "abst0055"
            "titulo" => "Resultados y limitaciones"
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            "identificador" => "abst0060"
            "titulo" => "Conclusiones"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Sundelin MO&#44; Silva JD&#44; Daele AV&#44; Savopoulos V&#44; Pirola GM&#44; Ranasinghe S&#44; et al&#46; <span class="elsevierStyleItalic">Boot camp</span> de simulaci&#243;n en urolog&#237;a&#58; perspectiva de los delegados no brit&#225;nicos&#46; Actas Urol Esp&#46; 2021&#59;45&#58;49&#8211;56&#46;</p>"
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          0 => array:4 [
            "apendice" => "<p id="par0180" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0080"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Module 1 &#40;simulation of a boari flap&#41;&#44; &#40;B&#41; Module 2 &#40;Testicular fixation&#41;&#44; &#40;C&#41; Module 3 Basic laparoscopy &#40;clipping the renal pedicle&#41;&#44; &#40;D&#41; Module 4 &#40;Transurethral resection of the prostate and bladder&#41;&#46;</p>"
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      1 => array:8 [
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        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
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        "mostrarDisplay" => false
        "figura" => array:1 [
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            "imagen" => "gr2.jpeg"
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            "Tamanyo" => 299754
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        "detalles" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Module 5 &#40;Emergency urology scenarios with a SimMan and an actor&#41;&#44; &#40;B&#41; Module 6 Female urology &#40;Botox training&#41;&#44; &#40;C&#41; Module 7&#44; Simulated wardround with actors and nursing staff&#44; &#40;D&#41; Module 8&#44; Ureteroscopy&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">UK trainee&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Non-UK trainee&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Number&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">76&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Mean duration of training &#40;months&#41; at all levels of training&#44; months &#40;&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">19&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean on call urology experience at all levels of training&#44; months &#40;&#61;&#47;&#8722;SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#46;38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;62&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">71&#46;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Question</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="5" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Score</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Strongly disagree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Disagree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Neutral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Agree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Strongly agree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">i&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Was the course relevant for you as a non-UK trainee&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;33&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;66&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ii&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">After returning to your own hospital&#44; do you feel that your operating skills have improved&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;11&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;44&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;44&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">iii&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">After returning to your own hospital&#44; do you feel that your non-technical skills have improved&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;11&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;55&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;33&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Did the feedback match to your self-assessment&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;22&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;77&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">v&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Has your course feedback made a behavioral change in your clinical everyday life&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;11&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;55&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;33&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">vi&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I enjoyed the boot camp and would recommend it to a non-UK trainee&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;11&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;88&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Itemized results from the simulation feedback form &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#41;&#46;</p>"
        ]
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          "fichero" => "mmc1.doc"
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    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:14 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of postgraduate medical education &#8220;boot camps&#8221; on clinical skills&#44; knowledge&#44; and confidence&#58; a meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46; Blackmore"
                            1 => "J&#46; Austin"
                            2 => "S&#46;R&#46; Lopushinsky"
                            3 => "T&#46; Donnon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4300/JGME-D-13-00373.1"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Grad Med Educ"
                        "fecha" => "2014"
                        "volumen" => "6"
                        "paginaInicial" => "643"
                        "paginaFinal" => "652"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26140112"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Boot camps&#58; preparing for residency"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;H&#46; Yeh"
                            1 => "K&#46; Fung"
                            2 => "S&#46; Malekzadeh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.otc.2017.05.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Otolaryngol Clin North Am"
                        "fecha" => "2017"
                        "volumen" => "50"
                        "paginaInicial" => "1003"
                        "paginaFinal" => "1013"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28669460"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Medical school surgical boot camps&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;J&#46; Neylan"
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