title: Mastery-Based Virtual Reality Robotic Simulation Curriculum: The First Step Toward Operative Robotic Proficiency.
abstract: OBJECTIVE
  Hepatobiliary surgery is a highly complex, low-volume specialty with long learning curves necessary to achieve optimal outcomes. This creates significant challenges in both training and measuring surgical proficiency. We hypothesize that a virtual reality curriculum with mastery-based simulation is a valid tool to train fellows toward operative proficiency. This study evaluates the content and predictive validity of robotic simulation curriculum as a first step toward developing a comprehensive, proficiency-based pathway.
  
  
  METHODS
  A mastery-based simulation curriculum was performed in a virtual reality environment. A pretest/posttest experimental design used both virtual reality and inanimate environments to evaluate improvement. Participants self-reported previous robotic experience and assessed the curriculum by rating modules based on difficulty and utility.
  
  
  METHODS
  This study was conducted at the University of Pittsburgh Medical Center (Pittsburgh, PA), a tertiary care academic teaching hospital.
  
  
  METHODS
  A total of 17 surgical oncology fellows enrolled in the curriculum, 16 (94%) completed.
  
  
  RESULTS
  Of 16 fellows who completed the curriculum, 4 fellows (25%) achieved mastery on all 24 modules; on average, fellows mastered 86% of the modules. Following curriculum completion, individual test scores improved (p < 0.0001). An average of 2.4 attempts was necessary to master each module (range: 1-17). Median time spent completing the curriculum was 4.2 hours (range: 1.1-6.6). Total 8 (50%) fellows continued practicing modules beyond mastery. Survey results show that "needle driving" and "endowrist 2" modules were perceived as most difficult although "needle driving" modules were most useful. Overall, 15 (94%) fellows perceived improvement in robotic skills after completing the curriculum.
  
  
  CONCLUSIONS
  In a cohort of board-certified general surgeons who are novices in robotic surgery, a mastery-based simulation curriculum demonstrated internal validity with overall score improvement. Time to complete the curriculum was manageable.
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: hoggme@upmc.edu.
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Hogg
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Vernissia
authors.initials: V
authors.lastname: Tam
authors.affiliation: Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Mazen
authors.initials: M
authors.lastname: Zenati
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Novak
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Miller
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Amer H
authors.initials: AH
authors.lastname: Zureikat
authors.affiliation: Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Zeh
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D002983:Clinical Competence; D015331:Cohort Studies; D003198:Computer Simulation; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D065287:Robotic Surgical Procedures / Q000193:education*; D000066908:Simulation Training / Q000379:methods*; D000071077:Surgical Oncology / Q000193:education*; D000076142:Virtual Reality
keywords: Practice-Based Learning and Improvement; Professionalism; mastery-based curriculum; robotic simulation; surgical education; surgical proficiency