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Proficiency-Based Training for Robotic Surgery: Feasibility and Inital Results
Genevieve Dulan*, Robert V. Rege, Deborah C. Hogg, Kristine M. Gilberg-Fisher, Seifu T. Tesfay, Daniel J. Scott
Surgery, UT Southwestern, Dallas, TX

Introduction: We previously developed a comprehensive, proficiency-based robotic training curriculum (online didactics, ½ day tutorial, and 9 inanimate exercises)that aimed to address 23 unique skills identified via task deconstruction of robotic operations. Prior studies supported construct, content, and face validity. The purpose of this study was to assess feasibility and educational outcomes following initial implementation. Methods: Novice robotic trainees(n=10, PGY3-5 residents) from 3 departments(General Surgery n=5, Urology n=3, Gynecology n=2) participated over 2 months in 1) online didactics, 2) hands-on tutorial, and 3) self-practice (individually scheduled sessions) using 9 inanimate exercises until proficiency levels were achieved. 5 exercises used FLS models with modifications (Peg, Clutch/Camera Peg, Pattern Cut, and Interrupted and Running Suture) and 4 used custom made components (Rubber Band, Stair Rubber Band, Clutch/Camera, and Cutting Rubber Band). Each task was scored for time and errors using modified FLS metrics; task scores were normalized to the proficiency level and a composite score equaled the sum of the 9 normalized task scores. Each trainee completed a questionnaire (5-point Likert scales) and performed a single proctored repetition of each task before (pre-test) and after (post-test) training. Training was supervised by a designated proctor and feedback was given upon request. Comparisons used Mann-Whitney tests; p<0.05 was considered significant. Results: While trainees felt moderately to very comfortable with their laparoscopic skills(3.5 ± 0.5), they had minimal prior robotic experience and poor comfort with robotic skills (1.9 ± 1.1) at baseline. All 10 trainees completed all curricular components in 9.5 to 12.0 hours. All trainees reached proficiency for all 9 exercises after completing an average of 69.3 ± 18.4 repetitions over 4.4 ± 0.9 hours; practice was completed during 3-5 self-practice sessions with moderate to extensive (4.6 ± 0.7) proctor feedback provided, which was rated as highly appropriate (4.9 ± 0.4). Proficiency levels were rated as moderately difficult (2.9 ± 0.4), highly appropriate (4.1 ± 0.2), and provided excellent feedback (100% agreement amongst trainees). Performance improved significantly after training for all 9 tasks and according to the composite scores (644.6 ± 205 vs. 942.5 ± 53, p< 0.001). 100% of trainees indicated that their robotic skills improved and self-rated comfort level improved from 1.9 ± 1.1 to 3.3 ± 1.0 (p = 0.002).Conclusion: These data indicate that initial implementation of the comprehensive robotic training curriculum was feasible with all participants completing training. Moreover, significant performance improvement was documented after a modest amount of practice with all trainees achieving proficiency. Further adoption of this curriculum is encouraged.


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