Prospective and Randomized Assessment of the Impact of Proficiency-based Progression E-learning Prior to Skills Training on a Robotic Surgical Task

Simulation-based training has been shown to be an effective way to prepare the trainee for the operating room. Gallagher et al. have demonstrated in a number of studies that proficiency-based progression (PBP) simulation training works best when it is integrated into a curriculum. Learning is optimal when trainees receive metric-based feedback on their performance. Metrics should unambiguously characterize important aspects of procedure or skill performance. They are developed from a task analysis of the procedure or skills to be learned. The outcome of the task analysis should also shape how the simulation looks and behaves. Metric-based performance characterization can be used to establish a benchmark (i.e., a level of proficiency) which trainees must demonstrate before training progression. This approach ensures a more homogeneous skill-set in graduating trainees and can be applied to any level of training. Prospective, randomized and blinded clinical studies have shown that trainees who acquired their skills to a level of proficiency on a simulator in the skills laboratory perform significantly better in vivo in comparison to their traditionally trained colleagues. Although simulation-based training has been shown to be very effective in helping trainees acquire skills for the operating room. Acquiring skills in the skills laboratory, outside the operating is no doubt significantly safer for patients as they can acquire skills at the start of their learning curve, away from the operating room. The skills laboratory is however a very expensive resource particularly for the acquisition of skills to used advanced technologies such as surgical robots. It is recognised that inadequate training in robotic surgery results in increased complications and higher costs. Standardising modular training with defined steps and the errors to avoid will enable proficiency-based progression (PBP) training. Skills training for robotic surgery is some of the most expensive training space in medicine. It therefore should be used efficiently.

E-learning is naturally suited for the delivery of multisensory information such as material associated with learning to perform surgery. It can provide a flexible learning environment that can be used as an adjunct to face-to-face teaching, skills laboratory training and clinical surgery training for both novice and very experienced operators. E-learning offers particularly exciting opportunities for augmenting the learning process in surgery and procedural medicine. For example, in a well-delivered traditional lecture, the academic has very few ways of knowing how effectively they have imparted the information that they are trying to communicate.

Furthermore, it would be unrealistic to expect that all of the audience would be learning at the same pace, but the traditional lecture is delivered in the standard 40 - 50 minute time period to the individuals sitting in the same room. The hope is that by the time of the exam, everyone is at a sufficient standard to at least pass the course. If the material is delivered on an e-platform, the progress of each individual can be tracked with a formative assessment process. This means that individuals who learn at a slower pace can have their education supplemented automatically or they can be flagged for direct academic intervention.

E-learning also suits the PBP methodology in that only trainees who have demonstrated the requisite proficiency benchmark actually get training in the skills laboratory. The aim of this study is to quantitatively assess the economic impact and cost savings (if any) of requiring trainees to study a robotic surgical task until they demonstrate a defined performance benchmark before commencing their technical skills training in the skills laboratory.

As recently outlined during the first European multi-specialty consensus meeting on robotic surgery training, a fundamental step in creating a proficient robotic surgeon is the acquisition of basic surgical skills, such as suturing, knotting, coagulating and dissecting. Among numerous dry models, the Venezuelan chicken model seems to be ideal for suturing, anastomosis and knotting exercises, not only in the urological field but in all robotic surgical disciplines. The participants will be working with this model.