Research Article: Computer-Enhanced Visual Learning Method to Teach Endoscopic Correction of Vesicoureteral Reflux: An Invitation to Residency Training Programs to Utilize the CEVL Method

Date Published: January 9, 2012

Publisher: Hindawi Publishing Corporation

Author(s): Michael Bauschard, Max Maizels, Andrew Kirsch, Martin Koyle, Tony Chaviano, Dennis Liu, Rachel Stork Stoltz, Evelyn Maizels, Michaella Prasad, Andrew Marks, David Bolnick.


Herein we describe a standardized approach to teach endoscopic injection therapy to repair vesicoureteral reflux utilizing the CEVL method, an internet-accessed platform. The content was developed through collaboration of the authors’ clinical and computer expertises. This application provides personnel training, examination, and procedure skill documentation through the use of online text with narration, pictures, and video. There is also included feedback and remediation of skill performance and teaching “games.” We propose that such standardized teaching and procedure performance will ultimate in improved surgical results. The electronic nature of communication in this journal is ideal to rapidly disseminate this information and to develop a structure for collaborative research.

Partial Text

The series of paper on urinary tract infection management in this electronic journal deal with controversies on the surgical management of children with vesicoureteral reflux. Herein, we address controversies in surgical management as could stem from a lack of standardized teaching of the procedure. We describe a new method to standardize teaching of correction of vesicoureteral reflux (VUR) by endoscopic injection.

Goals for each type of personnel in the operating room are presented as a checklist.

The checklist items for the procedure are shown (Table 1).

We have presented a new web application CEVL to promote standardization in teaching endoscopic injection therapy of pediatric VUR. Our anecdotal experiences in utilization of the module show it is well received by operating room staff, attendings, residents, and pediatric urology fellows (coauthors A. Marks and M. Prasad). We believe this is because the CEVL presentation of performance of the procedure explicitly using text with narration, pictures, and video as accessed by the operating room staff better integrates them into the procedure performance. The feedback and remediation application in CEVL permits residents to identify aspects of surgery most needy of remediation and thereby focus their practice in order to improve “next case” performance. CEVL provides administrative tools for residency program directors to monitor the progress of their trainees’ skill acquisition towards mastery by review of their skill scores. Furthermore CEVL utilization would develop data sets to show a timeline for the expected rate of skill acquisition to perform the procedure in residency training and/or standards for proficiency in performance.

The CEVL method is a novel approach to teach and perform endoscopic injection therapy which may be utilized by the entire OR staff. We believe it helps residents and staff to prepare and perform surgery by providing a shared knowledge to all operating room staff which familiarizes them with the procedure and its intricacies. The method is also amenable to be utilized for collaborative educational and clinical research on endoscopic surgery for vesicoureteral reflux.