Introduction: Transurethral resection of bladder (TURB) is a common procedure and should be mastered by every urologist. Recent surveys reported worrying data about residents’ capacity and confidence to perform a TURB safely. There is an imperative to standardize and improve TURB training programs. We are working to establish the first Proficiency-Based Progression (PBP) structured training curriculum for a TURB procedure. As a first step, we aimed to develop the metrics which characterized a reference approach to a TURB procedure, and to obtain expert consensus on the metrics in a modified Delphi meeting. Methods: A reference approach to piecemeal TURB was developed according to the PBP methodology. A core team of three TURB experts and a senior behavioral scientist deconstructed the procedure, characterizing procedure Phases, Steps, Errors, and Critical Errors of a piecemeal TURB. The identified performance metrics constitute an optimal approach for training purposes. Urological societies guidelines, published peer-review papers and clinical experience guided the metric development. Unedited videos of TURB were used for verification and refinement of the metrics. The metrics were then presented to an international group of procedure experts to evaluate the face and content validity of the metrics through a modified Delphi format. Results: The core team deconstructed the procedure identifying 6 procedure phases, 60 procedure steps, 43 errors, and 40 critical errors. The procedure metrics were presented in a 3 hours Delphi meeting where 15 experts from 6 Countries were included. Through a modified Delphi process, a reference case was identified as a standard elective TURB on a male patient, diagnosed after full diagnostic work-up with =4 bladder lesions, the largest one =3 cm. The international experts panel added 3 steps, 4 errors, 1 critical error. Fourteen steps, 5 errors and 3 critical errors were edited. At the end of the Delphi, 6 procedure phases, 63 procedure steps, 49 errors, and 38 critical errors were identified. A panel consensus of 100% on the resulting metrics was obtained. Conclusions: A core metrics team performed a detailed task deconstruction of a piecemeal TURB. The performance metrics were presented, edited, and approved by an international panel of experts. These metrics represent a common system to train and objectively assess trainee capacity to perform TURB. They will be used to develop the first PBP-based training curriculum for TURB. The metrics represent a milestone of change in the training paradigm for one of the most commonly performed urological procedures. SOURCE OF Funding: .
