Does quality assured eLearning provide adequate preparation for robotic surgical skills; a prospective, randomized and multi-center study

Stefano Puliatti, Marco Amato, Rui Farinha, Artur Paludo, Giuseppe Rosiello, Ruben De Groote, Andrea Mari, Lorenzo Bianchi, Pietro Piazza, Ben Van Cleynenbreugel, Elio Mazzone, Filippo Migliorini, Saverio Forte, Bernardo Rocco, Patrick Kiely, Alexandre Mottrie, Anthony G Gallagher, Stefano Puliatti, Marco Amato, Rui Farinha, Artur Paludo, Giuseppe Rosiello, Ruben De Groote, Andrea Mari, Lorenzo Bianchi, Pietro Piazza, Ben Van Cleynenbreugel, Elio Mazzone, Filippo Migliorini, Saverio Forte, Bernardo Rocco, Patrick Kiely, Alexandre Mottrie, Anthony G Gallagher

Abstract

Purpose: In particular after the onset of the COVID-19 pandemic, there was a precipitous rush to implement virtual and online learning strategies in surgery and medicine. It is essential to understand whether this approach is sufficient and adequate to allow the development of robotic basic surgical skills. The main aim of the authors was to verify if the quality assured eLearning is sufficient to prepare individuals to perform a basic surgical robotic task.

Methods: A prospective, randomized and multi-center study was conducted in September 2020 in the ORSI Academy, International surgical robotic training center. Forty-seven participants, with no experience but a special interest in robotic surgery, were matched and randomized into four groups who underwent a didactic preparation with different formats before carrying out a robotic suturing and anastomosis task. Didactic preparation methods ranged from a complete eLearning path to peer-reviewed published manuscripts describing the suturing, knot tying and task assessment metrics.

Results: The primary outcome was the percentage of trainees who demonstrated the quantitatively defined proficiency benchmark after learning to complete an assisted but unaided robotic vesico-urethral anastomosis task. The quantitatively defined benchmark was based on the objectively assessed performance (i.e., procedure steps completed, errors and critical errors) of experienced robotic surgeons for a proficiency-based progression (PBP) training course. None of the trainees in this study demonstrated the proficiency benchmarks in completing the robotic surgery task.

Conclusions: PBP-based e-learning methodology is an effective training method avoiding critical errors in the suturing and knotting task. Quality assured online learning is insufficient preparation for robotic suturing and knot tying anastomosis skills.

Trial registration: ClinicalTrials.gov Identifier: NCT04541615.

Keywords: Metrics; Proficiency-based progression; Surgical training; eLearning.

Conflict of interest statement

The authors declare that they have no conflict of interest.

© 2022. CARS.

Figures

Fig. 1
Fig. 1
The mean and 95% confidence intervals of scores for the four groups on the eLearning module completed before they were assessed on their technical performance of the robotic suturing and anastomosis task
Fig. 2
Fig. 2
a–c The mean and 95% CI of procedure steps, errors and critical errors made by the four groups of trainees on the robotic surgery vesico-urethral anastomosis model relative to the proficiency benchmark for each performance metric. Also shown are how far off the proficiency benchmark performance was

References

    1. Puliatti S, Eissa A, Eissa R, Amato M, Mazzone E, Dell'Oglio P, Sighinolfi MC, Zoeir A, Micali S, Bianchi G, Patel V, Wiklund P, Coelho RF, Bernhard JC, Dasgupta P, Mottrie A, Rocco B. COVID-19 and urology: a comprehensive review of the literature. BJU Int. 2020;125(6):E7–E14. doi: 10.1111/bju.15071.
    1. Khan S, Mian A. Medical education: COVID-19 and surgery. Br J Surg. 2020;107(8):e269. doi: 10.1002/bjs.11740.
    1. Figueroa F, Figueroa D, Calvo-Mena R, Narvaez F, Medina N, Prieto J. Orthopedic surgery residents’ perception of online education in their programs during the COVID-19 pandemic: should it be maintained after the crisis? Acta Orthop. 2020 doi: 10.1080/17453674.2020.1776461.
    1. Gallagher AG, O'Sullivan GC. Fundamentals of surgical simulation; principles & practices. London: Springer Verlag; 2011.
    1. Gallagher AG, Ritter EM, Champion H, Higgins G, Fried MP, Moses G, Smith CD, Satava RM. Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training. Ann Surg. 2005;241(2):364–372. doi: 10.1097/01.sla.0000151982.85062.80.
    1. García Vazquez A, Verde JM, Dal Mas F, Palermo M, Cobianchi L, Marescaux J, Gallix B, Dallemagne B, Perretta S, Gimenez ME. Image-guided surgical e-Learning in the post-COVID-19 pandemic era: what is next? J Laparoendosc Adv Surg Tech A. 2020;30(9):993–997. doi: 10.1089/lap.2020.0535.
    1. Puliatti S, Mazzone E, Amato M, De Groote R, Mottrie A, Gallagher AG. Development and validation of the objective assessment of robotic suturing and knot tying skills for chicken anastomotic model. Surg Endosc. 2020 doi: 10.1007/s00464-020-07918-5.
    1. Van Sickle KR, Ritter EM, Baghai M, Goldenberg AE, Huang IP, Gallagher AG, Smith CD. Prospective, randomized, double-blind trial of curriculum-based training for intracorporeal suturing and knot tying. J Am Coll Surg. 2008;207(4):560–568. doi: 10.1016/j.jamcollsurg.2008.05.007.
    1. Vanlander AE, Mazzone E, Collins JW, Mottrie AM, Rogiers XM, van der Poel HG, Van Herzeele I, Satava RM, Gallagher AG. Orsi consensus meeting on European robotic training (OCERT): results from the first multispecialty consensus meeting on training in robot-assisted surgery. Eur Urol. 2020;78(5):713–716. doi: 10.1016/j.eururo.2020.02.003.
    1. Gallagher AG, Ritter EM, Satava RM. Fundamental principles of validation, and reliability: rigorous science for the assessment of surgical education and training. Surg Endosc. 2003;17(10):1525–1529. doi: 10.1007/s00464-003-0035-4.
    1. Gallagher AG, Ryu RKN, Pedowitz RA, Henn P, Angelo RL. Inter-rater reliability for metrics scored in a binary fashion-performance assessment for an arthroscopic Bankart repair. Arthroscopy. 2018;34(7):2191–2198. doi: 10.1016/j.arthro.2018.02.007.
    1. Angelo RL, Ryu RK, Pedowitz RA, Beach W, Burns J, Dodds J, Field L, Getelman M, Hobgood R, McIntyre L, Gallagher AG. A proficiency-based progression training curriculum coupled with a model simulator results in the acquisition of a superior arthroscopic Bankart skill set. Arthroscopy. 2015;31(10):1854–1871. doi: 10.1016/j.arthro.2015.07.001.
    1. O’Herlihy N, Griffin S, Henn P, Gaffney R, Cahill MR, Gallagher AG. Validation of phlebotomy performance metrics developed as part of a proficiency-based progression initiative to mitigate wrong blood in tube. Postgrad Med J. 2020;97(1148):363–367. doi: 10.1136/postgradmedj-2019-137254.
    1. Gallagher A. Metric-based simulation training to proficiency in medical education: what it is and how to do it. Ulster Med J. 2012;81(3):107–113.
    1. Eden J, Berwick D, Wilensky G. Graduate medical education that meets the nation's health needs. Washington, D.C.: National Academies Press; 2014.
    1. Cameron JL. William Stewart Halsted: our surgical heritage. Ann Surg. 1997;225(5):445–458. doi: 10.1097/00000658-199705000-00002.
    1. Lowry J, Cripps J. Results of the online EWTD trainee survey. Bull R Coll Surg Engl. 2005;87(3):86–87. doi: 10.1308/147363505X36160.
    1. Carlin AM, Gasevic E, Shepard AD. Effect of the 80-hour work week on resident operative experience in general surgery. Am J Surg. 2007;193(3):326–330. doi: 10.1016/j.amjsurg.2006.09.014.
    1. Puliatti S, Mazzone E, Dell'Oglio P. Training in robot-assisted surgery. Curr Opin Urol. 2020;30(1):65–72. doi: 10.1097/MOU.0000000000000687.
    1. Healy GB. The college should be instrumental in adapting simulators to education. Bull Am Coll Surg. 2002;87(11):10–11.
    1. Gallagher AG. Proficiency-based progression simulation training for more than an interesting educational experience. J Musculoskelet Surg Res. 2018;2(4):139–141. doi: 10.4103/jmsr.jmsr_58_18.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する