J. L. Miller1, S. M. Novak1, D. L. Bartlett1, A. H. Zureikat1, H. J. Zeh1, M. E. Hogg1 1University Of Pittsburgh,Surgical Oncology/Surgery/Medicine,Pittsburgh, PA, USA
Introduction:
Robotic surgery is becoming widely used by general surgery and its specialties such as surgical oncology. Our institution has performed over 1,000 robotic surgical oncology cases and has identified the learning curve for several complex robotic resections. Critical to successful dissemination of the platform is a better understanding of how new surgeons learn the technology. This study aims to evaluate content and predictive validity of robotic simulation in surgery. We hypothesize mastery-based simulation is a valid tool to train residents and fellows toward operative proficiency.
Methods:
A mastery-based simulation curriculum was performed in a virtual reality environment. Mastery was defined as 90% proficiency on each module. A pretest/posttest experimental design utilized virtual reality M score tasks (Match Board 3, Ring & Rail 2, Tubes and Continuous Suture) and inanimate environments using video analysis (Ring Rollercoaster 4, Around the World and Interrupted Suture) to evaluate technical improvement. Prior robotic training experience and curriculum assessment was self-reported in a survey; fellows were asked to rate modules based on difficulty and utility using a Likert scale of 5 (5 being greatest).
Results:
11 fellows enrolled in the curriculum. Prior robotic simulator experience showed: min=0, max=31, median=0.375 and mode=0 hours. Prior robotic case experience demonstrated: min=0, max=50, median=12 and mode=4 cases. 9 fellows (82%) completed the mandatory curriculum. 7 fellows (77.8%) achieved mastery on all 24 modules (one deficient on 4, one deficient on 9). Individual test scores improved; overall time and errors decreased (Table). Of the 24 modules, frequency to mastery demonstrated: min=1, max=17, median=2. Simulator hours spent completing curriculum showed: min=1.1, max=6.6 and med=4.2. 9 (100%) fellows continued modules beyond mastery. Fellows rated modules between 1 and 5 for difficulty and 3 and 5 for utility. Needle driving and Endowrist 2 modules were perceived as most difficult; needle driving modules were most useful. 8 (89%) fellows perceived improvement in robotic skills after completing the curriculum.
Conclusion:
This pilot study is limited by sample size; however, these preliminary results show overall score improvement, decrease in errors and decrease in total time. Time to complete the curriculum is manageable.To increase power for statistical comparison, the study is ongoing to include incoming fellows, senior general surgery residents and other fellowship programs. Ultimately, the study will assess correlation between performance on simulator curriculum with inanimate biotissue curriculum and operative improvement to assess content and predictive validity.
