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CURRENT ROBOTIC CREDENTIALING AND PRIVILEGING IN THE UNITED STATES: A LACK OF STANDARDIZATION
Vernissia Tam*, Amer H. Zureikat, Herbert J. Zeh, Melissa E. Hogg
University of Pittsburgh Medical Center, Pittsburgh, PA
Background
The responsibility of safely implementing new surgical technology lies with individual institutions and necessitates weighing innovation with concerns for learning curves, patient outcomes, and cost. There is no standardization across training programs and a lack of consensus from societies to inform policies. The goal of this study was to determine how institutions across the U.S. are currently credentialing surgeons to perform robotic surgery.
Methods
A survey was distributed to the Intuitive Online Community e-mail list serve. The survey consisted of 30-items that assessed hospital background, current credentialing requirements, and perceived outlook of policy amendments. An e-mail reminder was delivered after 10 days and recipients had 30 days to complete the survey. Survey participation was anonymous, voluntary, and uncompensated.
Results
Online surveys were opened by 7278 recipients; responses from 557 (8%) participants were summarized. Most surgeons (54%) were in a community setting while 21% were in strictly academic practices; nearly half (45%) of respondents worked with residents. The most commonly reported departments performing robotic surgery at each institution were general surgery (20%), urology (19%), and gynecology (19%). Most respondents (82%) reported a mandatory, formal training curriculum enforced by their institution but the components of this formal training varied (Table 1). Proctored cases were the most frequently reported requirement (21%), and the average number of required proctored cases was 4.0 (SD 2.0). A minimum case volume was enforced in 16% of respondents and the average volume was 14 (SD 7.3) cases; 42% of respondents indicated these cases were only permitted as an attending (vs. trainee). Simulation was an institutional requirement amongst 12% of respondents. Recertification or requirements to maintain privileges were not required in 43% of respondents; however, some programs (30%) required a minimum annual case volume, though only 12% required monitoring patient outcomes. Few (11%) were aware of impending changes to credentialing policies; most responses indicated a desire to develop more stringent requirements for training and recertification.
Conclusions
There is significant variation across institutions for credentialing to perform robotic surgery. A small percentage of respondents indicated that their institutions require training outside of the operating room indicating that much of the learning curve is occurring on patients. As the field of robotic surgery matures, developing standardized benchmarks to assure appropriate training and competency should be necessary for institutions to safely introduce new technology. Developing and validating measures of technical proficiency that correlate to patient outcomes will present an opportunity to facilitate credentialing and assure patient safety.
Credentialing Committee Requirements
| Requirement | Proportion Required | Average cases required (SD) | | Proctored cases | 21% | 4.0 (2.0) | | Industry-sponsored hands-on training | 17% | | | Industry-sponsored online modules | 16% | | | Minimum case volume | 16% | 14 (7.3) | | Simulation training | 12% | | | Bedside assistant experience | 5.9% | 5.5 (2.8) | | Complications record | 5.4% | | | Re-certification or re-training | 3.6% | | | Senior mentorship program | 1.6% | | | Video-review | 1.0% | 5.9 (5.6) |
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