title: Comprehensive proficiency-based inanimate training for robotic surgery: reliability, feasibility, and educational benefit.
abstract: BACKGROUND
  We previously developed a comprehensive proficiency-based robotic training curriculum demonstrating construct, content, and face validity. This study aimed to assess reliability, feasibility, and educational benefit associated with curricular implementation.
  
  
  METHODS
  Over an 11-month period, 55 residents, fellows, and faculty (robotic novices) from general surgery, urology, and gynecology were enrolled in a 2-month curriculum: online didactics, half-day hands-on tutorial, and self-practice using nine inanimate exercises. Each trainee completed a questionnaire and performed a single proctored repetition of each task before (pretest) and after (post-test) training. Tasks were scored for time and errors using modified FLS metrics. For inter-rater reliability (IRR), three trainees were scored by two raters and analyzed using intraclass correlation coefficients (ICC). Data from eight experts were analyzed using ICC and Cronbach's α to determine test-retest reliability and internal consistency, respectively. Educational benefit was assessed by comparing baseline (pretest) and final (post-test) trainee performance; comparisons used Wilcoxon signed-rank test.
  
  
  RESULTS
  Of the 55 trainees that pretested, 53 (96 %) completed all curricular components in 9-17 h and reached proficiency after completing an average of 72 ± 28 repetitions over 5 ± 1 h. Trainees indicated minimal prior robotic experience and "poor comfort" with robotic skills at baseline (1.8 ± 0.9) compared to final testing (3.1 ± 0.8, p < 0.001). IRR data for the composite score revealed an ICC of 0.96 (p < 0.001). Test-retest reliability was 0.91 (p < 0.001) and internal consistency was 0.81. Performance improved significantly after training for all nine tasks and according to composite scores (548 ± 176 vs. 914 ± 81, p < 0.001), demonstrating educational benefit.
  
  
  CONCLUSIONS
  This curriculum is associated with high reliability measures, demonstrated feasibility for a large cohort of trainees, and yielded significant educational benefit. Further studies and adoption of this curriculum are encouraged.
authors.affiliation: Department of Surgery, Robotic Surgical Skills Training Laboratory, Southwestern Center for Minimally Invasive Surgery, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9156, USA. Nabeel.arain@UTsouthwestern.edu
authors.forename: Nabeel A
authors.initials: NA
authors.lastname: Arain
authors.forename: Genevieve
authors.initials: G
authors.lastname: Dulan
authors.forename: Deborah C
authors.initials: DC
authors.lastname: Hogg
authors.forename: Robert V
authors.initials: RV
authors.lastname: Rege
authors.forename: Cathryn E
authors.initials: CE
authors.lastname: Powers
authors.forename: Seifu T
authors.initials: ST
authors.lastname: Tesfay
authors.forename: Linda S
authors.initials: LS
authors.lastname: Hynan
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Scott
mesh_terms: D003479:Curriculum; D004521:Educational Measurement; D005240:Feasibility Studies; D013502:General Surgery / Q000193:education*; D013509:Gynecologic Surgical Procedures / Q000193:education*; D007396:Internship and Residency / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012371:Robotics / Q000193:education*; D013781:Texas; D013520:Urologic Surgical Procedures / Q000193:education*