S. B. Hays1,2, K. Kuchta2, A. E. Rojas2, S. A. Mehdi2, M. Talamonti2, M. E. Hogg2 1University Of Chicago, Chicago, IL, USA 2Northshore University Health System, Evanston, IL, USA
Introduction:
Over the past decade, robotic surgery has become widespread in general surgery. Accordingly, there is growing need for surgical residents to be proficiently trained in robotic surgery. However, there is currently no standardized resident robotic training curriculum. We hypothesized that the implementation of a mastery-based virtual reality simulation curriculum (VR) would improve trainee performance on both virtual reality and inanimate robotic simulation.
Methods:
The VR simulation curriculum was administered to PGY-3 general surgery residents from 2019-2022. The curriculum was completed on the da Vinci® Skill Simulator (DVSS). The training program used a pre/posttest design. Before beginning the training, residents completed a pretest that consisted of 4 VR exercises and 3 inanimate box trainer exercises. Residents were given a score (0-100%) for each VR exercise. The box trainer exercises were graded using the Objective Structured Assessment of Technical Skills (OSATS; range 6-30) by an expert surgeon. After completing the pretest, residents were tasked with completing a VR curriculum of 23 modules. Module mastery was defined as a score ≥ 90% and all “green checkmarks”. Residents were able to move on to the next module after achieving mastery or after 10 attempts. Time spent on each task and number of attempts until mastery was recorded. After completion of the curriculum, residents were given a post-test with the same exercises as the pretest to assess their skills and proficiency.
Results:
23 residents completed the robotic curriculum. 78% reported experience at the surgeon console prior to this curriculum (median=4 operations). Residents with prior experience completed the inanimate modules faster than those with no prior experience (mean 984 vs 1441 seconds, p=0.028). There was a trend towards higher VR scores and higher OSATS scores among residents with prior robotic experience, but this was not statistically significant. 34.8% of residents achieved mastery on all modules in the curriculum. On average, 22/23 modules were mastered. Match Board 1 and Ring Walk 3 were the most difficult modules to master with 30.4% and 43.5% of residents needing >10 attempts respectively. Average time to complete the curriculum was 3.8 hours. After curriculum completion, resident performance improved from pre-test to post-test across all three metrics. VR test scores increased (160% vs 223%, p<0.001), OSATS scores increased (15.0 vs 21.0, p<0.001), and time to completion of inanimate exercises decreased (1083 vs 756 seconds, p=0.001). The residents who mastered 100% of the modules had higher posttest VR scores (241% vs 214%, p=0.024). They also had higher average OSATS scores and shorter inanimate completion time, but these findings were not statistically significant.
Conclusion:
Mastery-based VR training curriculum improved performance in VR and inanimate testing, especially when 100% of modules were mastered, with minimal time commitment.