K. D. Gray1, J. Burshtein1, T. M. Ullmann1, A. Elmously1, T. Beninato1, C. Afaneh1, T. J. Fahey1, R. Zarnegar1 1NEW YORK-PRESBYTERIAN-CORNELL,New York, NY, USA
Introduction: Exposure to minimally invasive surgical techniques during residency is becoming increasingly important for surgical trainees. Our center developed a curriculum using the Da Vinci (Intuitive Surgical, Inc., Sunnyvale, CA) robotic simulation console that is available to all residents. We aimed to evaluate if skill acquisition and decay were related to post-graduate year.
Methods: After implementation of a robotic curriculum in June 2016, residents in General Surgery (GS), Urology, and Obstetrics-Gynecology were given unlimited access to the console equipped with over 50 training modules selected by faculty. An overall score of 90% in each exercise was considered proficient, which was calculated by subtracting a penalty subscore from the efficiency subscore. Individual performance was tracked using unique login identifiers. Data was collected for all residents on the most commonly performed modules (n=18) over the first year of the robotic curriculum and analyzed by exercise type (coordination versus suturing) and PGY level.
Results: A total of 40 residents were included; 32/40 (80%) were GS residents and 23/40 (57.5%) were male. The median number of sessions on the simulator was 3 (range 1 – 15).
PGY level had no effect on initial score in coordination exercises (p = 0.28) or suturing exercises (p = 0.29) or on the number of attempts required to achieve proficiency for a given exercise (p = 0.70). PGY1s were most likely to be penalized for poor economy of motion (p < 0.001), whereas PGY5s were most likely to be penalized for excessive force (p < 0.001). Skill acquisition varied by exercise type (Figure). For coordination exercises, efficiency plateaued after the second attempt, and a passing score was subsequently reached by reduction in the penalty score. For suturing exercises, efficiency continued to increase with the number of attempts until a passing score was reached.
Decay in skillset over time was observed in coordination exercises but not suturing exercises. In coordination exercises, a significantly greater median number of attempts were required to pass when comparing the initial session to sessions after six months without simulator exposure (3 attempts, IQR 2-5 versus 9 attempts, IQR 4.5 – 22.5, p = 0.006). This difference was not seen in suturing exercises (3 attempts, IQR 2 – 4.5 versus 3 attempts, IQR 2 – 4, p = 0.31).
Conclusion: Proficiency in robotic training modules can be achieved regardless of level of training. Coordination and suturing skills are acquired via different pathways, and suturing is a more durable skillset. Regular access to a robotic simulator beginning early in training has the potential to establish and sustain robotic skills.
