S. N. Chu1, C. A. Green2, H. Chern2, P. O’Sullivan2,3 1University Of California – San Francisco,School Of Medicine,San Francisco, CA, USA 2University Of California – San Francisco,Department Of Surgery,San Francisco, CA, USA 3University Of California – San Francisco,Department Of Medicine,San Francisco, CA, USA
Introduction: Surgical robotics has rapidly emerged in minimally invasive surgery with adoption and expansion into many surgical disciplines. Surgical educators are pressed to integrate robotic training during residency to adequately equip surgical trainees. However, they lack insight about appropriate operative instruction with robotics. We conducted a wet lab using live tissue and robotic technology to observe the instructional behaviors of attendings teaching residents in a robotic environment.
Methods: At the beginning of the 2017 academic year, senior surgical residents at the University of California, San Francisco completed a four-hour session receiving hands-on experience manipulating live porcine tissue using the da Vinci Surgical System (Intuitive Surgical, Sunnyvale CA). Residents first worked through a series of tissue manipulation drills and then completed a variety of surgical procedures (cholecystectomy, ventral hernia repair, sigmoid colectomy). Instructors, one-on-one, guided residents with the stipulation that they could not touch the operative console. Chen has developed a taxonomy of operating room teaching behaviors for open and laparoscopic surgery. We developed a structured observational form using these teaching behaviors and three independent observers documented instructional behaviors in real time. Through content analysis, researchers summarized the types and frequencies of these behaviors.
Results: Six instructors taught six residents. Instructors represented surgical specialties of colorectal, thoracic, bariatric and general surgery. Four faculty had 2-8 years of robotic experience and two teaching residents had less than a year of experience. Instructors predominantly and consistently used three distinct teaching behaviors, comprising over 75% of all behaviors used to instruct residents. The three behaviors were: verbal direction or re-direction, explaining thought process or decision and complimenting. Instructors employed this subset and frequency of behaviors regardless of specialty area or level of experience. Additionally, instructors displayed higher frequency of active versus passive teaching methodologies (i.e. proactive questioning).
Conclusion: Instructors consistently used a distinct set of teaching behaviors to guide their robotic surgical teaching that varied significantly from those seen in open and laparoscopic cases. Given the constraints of the individual robotic console, which consequently requires instruction from the periphery, experienced surgeons cannot employ many common instructional techniques such as directly pointing out anatomical structures with fingers or instruments or indirectly with a camera, which constitute two of the most highly used instructional behaviors in an open or laparoscopic setting. Further qualitative analysis of successful robotic teaching methodologies will provide guidance for instructional methods and evidence-based curriculum for teaching in this new environment.