{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T22:45:26Z","timestamp":1773355526899,"version":"3.50.1"},"reference-count":19,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the cost\u2010effectiveness of proficiency\u2010based progression (PBP) training compared to conventional surgical training approaches, and to determine whether PBP training implementation is economically justified when scaled to large numbers of trainees.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Economic analysis was performed using data from the prospective, randomised, and blinded Orsi Surgical Skills E\u2010learning Trial (OSSET;\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                      identifier: NCT04541615) at ORSI Academy (Belgium), where 47 medical trainees without prior robotic surgery experience were randomised into four groups, each with progressively reduced adherence to the PBP methodology. All trainees completed simulation\u2010based training on a validated bladder\u2010urethra anastomosis model, ranging from full PBP training with metric\u2010based assessment and proficiency benchmarks (Group 1) to a traditional apprenticeship model (Group 4). The primary outcome was training cost, evaluated per trainee and based on programme scalability (12\u2013500 trainees), including expenses for accommodation, laboratory time, and metric development. Cost equivalence points and scalability thresholds were identified to compare the financial impact of the four training strategies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The PBP training was more expensive than conventional methods for small cohorts (e.g. \u20ac14\u2009139 vs \u20ac7067 per trainee for 12 trainees), but became significantly more cost\u2010effective beyond 25 trainees (equivalence point). At 500 trainees, total PBP training cost was \u20ac1.69 million compared to \u20ac3.53 million for conventional training, a 110% cost advantage. All differences were statistically significant (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We conclude that PBP training is significantly more effective and becomes increasingly cost\u2010efficient as the number of trainees increases. These findings support its integration into high\u2010volume national training programmes, offering a scalable and economically sustainable alternative to apprenticeship\u2010based surgical education.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.70130","type":"journal-article","created":{"date-parts":[[2026,1,3]],"date-time":"2026-01-03T03:00:00Z","timestamp":1767409200000},"page":"493-501","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Randomised trial on the economic impact of proficiency\u2010based progression vs conventional robotic surgical training"],"prefix":"10.1111","volume":"137","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1597-9595","authenticated-orcid":false,"given":"Stefano","family":"Puliatti","sequence":"first","affiliation":[{"name":"University of Modena and Reggio Emilia  Modena Italy"},{"name":"Department of Urology Azienda Ospedaliero\u2010Universitaria di Modena  Modena Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3057-3805","authenticated-orcid":false,"given":"Natali","family":"Rodriguez Pe\u00f1aranda","sequence":"additional","affiliation":[{"name":"University of Modena and Reggio Emilia  Modena Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Amato","sequence":"additional","affiliation":[{"name":"Department of Urology Azienda Ospedaliero\u2010Universitaria di Modena  Modena Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4081-8221","authenticated-orcid":false,"given":"Ruben","family":"De Groote","sequence":"additional","affiliation":[{"name":"Department of Urology Onze\u2010Lieve\u2010Vrouw Hospital  Aalst Belgium"},{"name":"Orsi Academy  Melle Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1286-1399","authenticated-orcid":false,"given":"Rui","family":"Farinha","sequence":"additional","affiliation":[{"name":"Orsi Academy  Melle Belgium"},{"name":"Centro Hospitalar Universit\u00e1rio de Lisboa Central EPE  Lisbon Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brendan","family":"Bunting","sequence":"additional","affiliation":[{"name":"School of Psychology Ulster University  Coleraine UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9517-3673","authenticated-orcid":false,"given":"Ben","family":"van Cleynenbreugel","sequence":"additional","affiliation":[{"name":"School of Psychology Ulster University  Coleraine UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandre","family":"Mottrie","sequence":"additional","affiliation":[{"name":"Department of Urology Onze\u2010Lieve\u2010Vrouw Hospital  Aalst Belgium"},{"name":"Orsi Academy  Melle Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony G.","family":"Gallagher","sequence":"additional","affiliation":[{"name":"Orsi Academy  Melle Belgium"},{"name":"Department of Development and Regeneration KU Leuven  Leuven Belgium"},{"name":"School of Medicine, Faculty of Life and Health Sciences Ulster University  Londonderry UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,1,2]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/bju.15811"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2008.00227.x"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000004650"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2024.04.008"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.23736\/S2724\u20106051.25.06367\u20100"},{"key":"e_1_2_8_7_1","article-title":"A comparison of surgical subspecialty match rates in 2022 in the United States","volume":"15","author":"Lavertue SM","year":"2023","journal-title":"Cureus"},{"key":"e_1_2_8_8_1","unstructured":"Inforegio \u2010 Modernising health services with a new robotic training centre in Belgium. Accessed June 26 2025.https:\/\/ec.europa.eu\/regional_policy\/projects\/projects\u2010database\/modernising\u2010health\u2010services\u2010with\u2010a\u2010new\u2010robotic\u2010training\u2010centre\u2010in\u2010belgium_en"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-020-07918-5"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-200210000-00008"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2015.07.001"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2020.11.040"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.22750"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2408679"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1300625"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2020.1004"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjstel-2015-000090"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2008.05.007"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2006.06.050"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-020099"}],"container-title":["BJU International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bju.70130","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/bju.70130","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bju.70130","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T11:58:35Z","timestamp":1773316715000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/10.1111\/bju.70130"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,2]]},"references-count":19,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1111\/bju.70130"],"URL":"https:\/\/doi.org\/10.1111\/bju.70130","archive":["Portico"],"relation":{},"ISSN":["1464-4096","1464-410X"],"issn-type":[{"value":"1464-4096","type":"print"},{"value":"1464-410X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,2]]},"assertion":[{"value":"2026-01-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}