Can all surgical trainees be trained to proficiency for a robotic urethro-vesical anastomotic task using a chicken model? A prospective, randomized trial.

Abstract

Background: Proficiency based progression (PBP) is a very effective method of training and has been adopted by the European Robotic Surgical Section (ERUS) for robotic skills training. No study has addressed whether all learners can be trained to the proficiency benchmark. In this study, we evaluated: 1) if all trainees reached a quantitatively defined proficiency benchmark for a robotic suturing and knot tying anastomosis task; and 2) the number of training trials required.

Methods: In a multi-center, prospective, randomized, study, 48 participants were randomized to: 1) a PBP group that received e-learning on the ORSI chicken anastomosis task with the requirement to reach the proficiency benchmark before starting practical training; 2) e-learning group, received the exact same curriculum as group 1, but with no proficiency requirement on the e-learning; 3) traditional group received the exact same curriculum in face-to-face lectures; 4) the apprenticeship group received a conventional preparation.

Results: All participants, except five in group 4, demonstrated the proficiency benchmark. Group 1 took ~6 trials (~3 hours); group 2 required 14% longer, group 3, 103% (P<0.001) and in group 4, 58% of trainees demonstrated the benchmark but took 162% (P<0.001) longer. This was a small-scale but robust study with substantial effect sizes.

Conclusions: All PBP trainees demonstrated the proficiency benchmark in comparison to 58% of conventional trained group. As adherence to the PBP methodology decreased, the efficiency of proficiency demonstration significantly reduced.