title: Crowdsourcing: a valid alternative to expert evaluation of robotic surgery skills.
abstract: BACKGROUND
  Robotic-assisted gynecologic surgery is common, but requires unique training. A validated assessment tool for evaluating trainees' robotic surgery skills is Robotic-Objective Structured Assessments of Technical Skills.
  
  
  OBJECTIVE
  We sought to assess whether crowdsourcing can be used as an alternative to expert surgical evaluators in scoring Robotic-Objective Structured Assessments of Technical Skills.
  
  
  METHODS
  The Robotic Training Network produced the Robotic-Objective Structured Assessments of Technical Skills, which evaluate trainees across 5 dry lab robotic surgical drills. Robotic-Objective Structured Assessments of Technical Skills were previously validated in a study of 105 participants, where dry lab surgical drills were recorded, de-identified, and scored by 3 expert surgeons using the Robotic-Objective Structured Assessments of Technical Skills checklist. Our methods-comparison study uses these previously obtained recordings and expert surgeon scores. Mean scores per participant from each drill were separated into quartiles. Crowdworkers were trained and calibrated on Robotic-Objective Structured Assessments of Technical Skills scoring using a representative recording of a skilled and novice surgeon. Following this, 3 recordings from each scoring quartile for each drill were randomly selected. Crowdworkers evaluated the randomly selected recordings using Robotic-Objective Structured Assessments of Technical Skills. Linear mixed effects models were used to derive mean crowdsourced ratings for each drill. Pearson correlation coefficients were calculated to assess the correlation between crowdsourced and expert surgeons' ratings.
  
  
  RESULTS
  In all, 448 crowdworkers reviewed videos from 60 dry lab drills, and completed a total of 2517 Robotic-Objective Structured Assessments of Technical Skills assessments within 16 hours. Crowdsourced Robotic-Objective Structured Assessments of Technical Skills ratings were highly correlated with expert surgeon ratings across each of the 5 dry lab drills (r ranging from 0.75-0.91).
  
  
  CONCLUSIONS
  Crowdsourced assessments of recorded dry lab surgical drills using a validated assessment tool are a rapid and suitable alternative to expert surgeon evaluation.
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Duke University, Durham, NC. Electronic address: michael.polin@duke.edu.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Polin
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Duke University, Durham, NC.
authors.forename: Nazema Y
authors.initials: NY
authors.lastname: Siddiqui
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, WA.
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Comstock
authors.affiliation: Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, PA.
authors.forename: Helai
authors.initials: H
authors.lastname: Hesham
authors.affiliation: Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, PA.
authors.forename: Casey
authors.initials: C
authors.lastname: Brown
authors.affiliation: Division of Pediatric Urology, Department of Urology, University of Washington, Seattle, WA.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Lendvay
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, PA; Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, PA.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Martino
mesh_terms: D002983:Clinical Competence; D063045:Crowdsourcing; D004521:Educational Measurement / Q000379:methods*; D013509:Gynecologic Surgical Procedures / Q000193:education* / Q000592:standards; D006801:Humans; D007194:India; D016014:Linear Models; D008800:Mexico; D015588:Observer Variation; D065287:Robotic Surgical Procedures / Q000193:education* / Q000592:standards; D000066908:Simulation Training; D014481:United States; D014741:Video Recording
keywords: crowdsourcing; robotic surgery; simulation; surgical training