1-year Skill Retention Following Proficiency-Based Training for Robotic Surgery

Julia F Chen, Andrea M Alexander, MD, Deborah C Hogg, BS, Daniel J Scott, MD

UT Southwestern Medical Center

Introduction: We previously reported face, content, and construct validity as well as high reliability measures and significant performance improvement for 9 inanimate exercises as part of a comprehensive, proficiency-based robotic training curriculum. The purpose of this study was to determine 1-year skill retention for this curriculum.

Methods: Over a 2-year period, novice robotic trainees (n=90: 76 residents, 5 faculty, and 9 fellows) from general surgery (n=34), urology (n=24), and gynecology (n=32) successfully completed a 2-month curriculum which included: 1) online-didactics, 2) half-day hands-on tutorial, and 3) self-practice using 9-inanimate exercises until proficiency levels were achieved. Five exercises used FLS models with modifications and 4 used custom-made components. Each task was scored for time and errors using modified FLS metrics; task scores were normalized to proficiency levels and a composite score equaled the sum of the 9 normalized task scores. Each participant performed a single proctored repetition of each task before (pretest) and after (post-test) their initial training. Available trainees were invited to complete two additional repetitions (Rep1 and Rep2) of all 9 tasks at least six months after initial training to determine skill retention. Questionnaires were completed to document interval robotic experience. Comparisons used ANOVA on ranks; mean ± s.d. reported.

Results: 27 trainees (general surgery (n=7), urology (n=8), and gynecology (n=12)) participated in retention testing 12.5 ± 4.8 months after initial training. All trainees demonstrated significant improvement during initial training: pretest score 550 ± 147 vs. post-test 940 ± 50, p<0.001. A significant amount of skill loss (14.0%) was detected at retention testing (Rep1 809 ± 89, p<0.001 vs. post-test). A non-significant amount of improvement was detected on further retention testing (Rep2 848 ± 9, p=n.s. vs. Rep1). Ultimate skill retention (Rep2 vs. post-test) for the entire cohort was 90.2% and ultimate performance (Rep2) was not significantly different from performance immediately after training (post-test). Individuals who did not perform interval robotic cases had significantly worse retention (81.3%) compared to those with interval experience (90.9%, p=.013). Similarly, individuals who required a large amount of practice (>80 repetitions) during initial training had significantly worse retention (79.7%) compared to those who required less initial practice (89.6%, p=.017).

Conclusions: These data suggest that the proficiency-based curriculum is robust, yielding a very high level of skill retention. However, interval operative experience was associated with the smallest amount of skill loss. Skill also improved with minimal additional practice (i.e. by Rep2). For individuals who do not routinely perform robotic operations, additional simulation-based practice may be beneficial in optimizing skill retention.

Session: Poster Presentation

Program Number: P641