Abstract
Background
We previously developed a comprehensive proficiency-based robotic training curriculum demonstrating construct, content, and face validity. This study aimed to assess reliability, feasibility, and educational benefit associated with curricular implementation.
Methods
Over an 11-month period, 55 residents, fellows, and faculty (robotic novices) from general surgery, urology, and gynecology were enrolled in a 2-month curriculum: online didactics, half-day hands-on tutorial, and self-practice using nine inanimate exercises. Each trainee completed a questionnaire and performed a single proctored repetition of each task before (pretest) and after (post-test) training. Tasks were scored for time and errors using modified FLS metrics. For inter-rater reliability (IRR), three trainees were scored by two raters and analyzed using intraclass correlation coefficients (ICC). Data from eight experts were analyzed using ICC and Cronbach’s α to determine test-retest reliability and internal consistency, respectively. Educational benefit was assessed by comparing baseline (pretest) and final (post-test) trainee performance; comparisons used Wilcoxon signed-rank test.
Results
Of the 55 trainees that pretested, 53 (96 %) completed all curricular components in 9–17 h and reached proficiency after completing an average of 72 ± 28 repetitions over 5 ± 1 h. Trainees indicated minimal prior robotic experience and “poor comfort” with robotic skills at baseline (1.8 ± 0.9) compared to final testing (3.1 ± 0.8, p < 0.001). IRR data for the composite score revealed an ICC of 0.96 (p < 0.001). Test-retest reliability was 0.91 (p < 0.001) and internal consistency was 0.81. Performance improved significantly after training for all nine tasks and according to composite scores (548 ± 176 vs. 914 ± 81, p < 0.001), demonstrating educational benefit.
Conclusion
This curriculum is associated with high reliability measures, demonstrated feasibility for a large cohort of trainees, and yielded significant educational benefit. Further studies and adoption of this curriculum are encouraged.
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References
Orvieto MA, Patel VR (2009) Evolution of robot-assisted radical prostatectomy. Scand J Surg 98:76–88
Weinberg L, Rao S, Escobar PF (2011) Robotic surgery in gynecology: an updated systematic review. Obstet Gynecol Int 2011:852061
Lee JY, Mucksavage P, Sundaram CP, McDougall EM (2011) Best practices for robotic surgery training and credentialing. J Urol 185:1191–1197
Zorn KC, Gautam G, Shalhav AL, Clayman RV, Ahlering TE, Albala DM, Lee DI, Sundaram CP, Matin SF, Castle EP, Winfield HN, Gettman MT, Lee BR, Thomas R, Patel VR, Leveillee RJ, Wong C, Badlani GH, Rha KH, Eggener SE, Wiklund P, Mottrie A, Atug F, Kural AR, Joseph JV, Members of the Society of Urologic Robotic Surgeons (2009) Training, credentialing, proctoring and medico-legal risks of robotic urological surgery: recommendations of the society of urologic robotic surgeons. J Urol 182:1126–1132
Dulan G, Rege RV, Hogg DC, Gilberg-Fisher KM, Arain NA, Tesfay ST, Scott DJ (2012) Developing a comprehensive, proficiency-based training program for robotic surgery. Surgery (in press)
Dulan G, Rege RV, Hogg DC, Gilberg-Fisher K, Tesfay ST, Scott DJ (2012) Content and face validity of a comprehensive skills training program for general surgery, urology, and gynecology robotic operations. Am J Surg 203(4):535–539
Dulan G, Rege RV, Hogg DC, Gilberg-Fisher K, Arain NA, Tesfay ST, Scott DJ (2012) Proficiency-based training for robotic surgery: construct validity, workload, and expert levels for nine inanimate exercises. Surg Endosc. doi:10.1007/s00464-011-2102-6
Gallagher AG, Ritter EM, Satava RM (2003) Fundamental principles of validation, and reliability: rigorous science for the assessment of surgical education and training. Surg Endosc 17:1525–1529
Fried GM, Feldman LS, Vassiliou MC, Fraser SA, Stanbridge D, Ghitulescu G, Andrew CG (2004) Proving the value of simulation in laparoscopic surgery. Ann Surg 240:518–528
Fried GM, Feldman LS (2008) Objective assessment of technical performance. World J Surg 32:156–160
Vassiliou MC, Ghitulescu GA, Feldman LS, Stanbridge D, Leffondre K, Sigman HH, Fried GM (2006) The MISTELS program to measure technical skill in laparoscopic surgery: evidence for reliability. Surg Endsoc 20:744–747
Goh AC, Goldfarb DW, Sander JC, Miles BJ, Dunkin BJ (2012) Global evaluative assessment of robotic skills: validation of a clinical assessment tool to measure robotic surgical skills. J Urol 187(1):247–252
Gall M, Borg W, Gall J (1996) Educational research: an introduction. Longman, White Plains
Disclosures
Nabeel A. Arain, Genevieve Dulan, Deborah C. Hogg, Robert V. Rege, Cathryn E. Powers, Seifu T. Tesfay, Linda S. Hynan, and Daniel J. Scott have no conflicts of interest or financial ties to disclose.
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Presented at the SAGES 2012 Annual Meeting, March 7–March 10, 2012, San Diego, CA.
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Arain, N.A., Dulan, G., Hogg, D.C. et al. Comprehensive proficiency-based inanimate training for robotic surgery: reliability, feasibility, and educational benefit. Surg Endosc 26, 2740–2745 (2012). https://doi.org/10.1007/s00464-012-2264-x
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DOI: https://doi.org/10.1007/s00464-012-2264-x