Proficiency-based progression process training for fundamentals of robotic surgery curriculum development

As robotic surgery emerged, there was an obvious need for structured training. There were previous published courses, however they were by single institutions focusing upon local needs. The Fundamentals of Robotic Surgery (FRS) is a basic technical skills curriculum (course) which was developed by all 11 specialties performing robotic surgery and validated in a multi-specialty, multi-institutional surgical trial. The FRS skills course was created using the Full Life Cycle Development method, with 4 Delphi consensus conferences consisting of representatives from all surgical specialties performing robotic surgery, who provided the course outcomes measures/metrics and content, from which a physical and virtual reality (VR) simulation models were created. Training and assessment occurred using Proficiency-based Progression (PBP) process with outcomes measures to quantitative metrics (benchmarks)-meaning a score that is based on experienced surgeons' performance must be met before allowing the learner to progress to clinical surgery. The Validation Trial Design was a multi-institutional, multispecialty, single-blinded, parallel group randomized control trial. Transfer-of-training effectiveness was demonstrated by pre-test/ post-test animal-parts model. The primary outcome measure (the course can accurately train and assess the technical performance of basic surgical skills) demonstrated the effectiveness of the PBP process of the FRS course. The secondary outcomes measure (learners performed equally well on the physical Dome, and the two computer simulated VR Domes compared to controls), indicating that performance on a simulator is equal to using physical models. Additional outcome measures demonstrated statistically significant better 'quality of assessment' was achieved by a binary checklist than using a global assessment Likert scale such as Global Evaluative Assessment of Robotic Surgery (GEARS) for training basic technical skills. The evidence from the evaluation of the quantitative assessment of performance to proficiency demonstrated effectiveness for training basic technical skills with the FRS standardized course for robotic surgery, prompting us to advocate that all surgical specialties' training programs for robotic surgery should pass the FRS before progressing to advanced training and clinical robotic surgery. In addition, future robotic surgery course development should utilize the PBP process and templates.