Standardizing Rezūm training with high-fidelity simulation: is technical performance associated with age?

Abstract

Aim: To assess whether chronological age (≤ 35 years vs. > 35 years) is associated with technical performance during a standardized high-fidelity Rezūm simulation pathway.

Methods: This retrospective observational simulation-based study was conducted within a national itinerant Rezūm training program across 46 Italian institutions between June 2023 and July 2025. Board-certified urologists and senior residents (postgraduate years 4-5) who were Rezūm-naïve and had no prior simulator exposure were enrolled and stratified into Junior (≤ 35 years) and Senior (> 35 years) cohorts. After completing a standardized online theoretical module and qualification test, participants underwent a single-pass assessment without familiarization, repetition, or real-time feedback. Five fixed-order scenarios of increasing anatomical and cognitive complexity were completed. The primary outcome was the scenario-specific normalized simulator score (0-100).

Results: Overall, 460 participants were included (Junior, n = 120; Senior, n = 340). Mean scores were similar in Scenario 1 (93.38 vs. 93.30; P = 0.89) and Scenario 2 (89.59 vs. 89.21; P = 0.61). Junior participants scored higher in Scenario 3 (84.98 vs. 80.69; P < 0.01) and Scenario 4 (93.55 vs. 91.56; P < 0.01), whereas Senior participants showed higher scores in Scenario 5 (95.55 vs. 93.85; P = 0.02).

Conclusion: Chronological age was not consistently associated with simulator performance. Differences were modest and scenario-specific, supporting standardized high-fidelity simulation while underscoring the need for transfer-validity studies and Rezūm-specific proficiency benchmarks.

Keywords

Benign prostatic hyperplasia / Rezūm / simulation-based training / surgical education / competency-based assessment

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