RoCS: Robotic Curriculum for young Surgeons

Impact of a "Digital Health" Curriculum on Students' Perception About Competence and Relevance of Digital Health Topics for Future Professional Challenges: Prospective Pilot Study

Background

The rapid integration of digital technologies in health care has emphasized the need to ensure that medical students are well-equipped with the knowledge and competencies related to digital health.

Objective

This study aimed to evaluate the impact of the "Digital Health" curriculum at our university on the perceptions of medical students regarding the relevance of digital health topics for their future professions and their self-assessed competence in these areas.

Methods

The "Digital Health" curriculum was introduced at a German university for 2 consecutive semesters. The perceived relevance of topics for their future careers and their subjective competence were evaluated before and after the curriculum using a Likert scale. Furthermore, the practical gamification-based teaching part of the robotics teaching unit was evaluated. In total, 6 months after completing the last semester, a follow-up analysis was performed with questions on the significance of the completed curriculum for current and future professional challenges regarding digital health and suggestions for improvement for innovative teaching. The study was meticulously planned and supported by an approved ethics vote of the local ethics committee to ensure that all ethical guidelines were adhered to (A 2022-0137).

Results

A total of 20 students participated, with 13 (65%) being women. In particular, data protection and information security were considered the most relevant topics both before and after the curriculum. Significant increases in perceived importance were observed for messenger apps (mean increase of 0.8 [SD 1.2]; P<.01). Regarding self-assessed competence, significant development was observed on almost all topics. The greatest development was observed in robotics (mean increase of 1.8 [SD 1.2]; P<.001), open educational resources (mean increase of 1.7 [SD 1.5]; P<.001), and simulation-training (mean increase of 1.6 [SD 1.3]; P<.001). The gamification-based, robot-related teaching was predominantly rated suitable and very enjoyable for the students.

Conclusions

The results highlight the potential to integrate more innovative teaching techniques, such as gamification, augmented reality, virtual reality, and simulation training, into a technologically advanced health care environment. Finally, the overarching importance of artificial intelligence and digital health applications signals the need to further integrate them, given their potential in remote and personalized medicine.

How robotic platforms are revolutionizing colorectal surgery techniques: a comparative review

INTRODUCTION

In the last two decades, robotic technology has fundamentally transformed the field of colorectal surgery by providing surgeons with unprecedented levels of precision and control. Nevertheless, robotic surgery presents certain challenges such as prolonged operating times, high costs, limited accessibility, and the necessity for specialized training.

AREAS COVERED

This comparative review analyzes the impact of robotic platforms on colorectal surgery and its outcomes, with the expanding market of this technology. The major databases including PubMed, Scopus, and Google Scholars were searched using the key term 'robotic assisted surgery,' 'robotic platforms,' and 'colorectal surgery' to identify relevant articles as of August 2024. The most utilized robotic platforms currently available on the market - Da Vinci, Versius, Senhance, and Revo-I - are compared through their peri- and post-operative outcomes, including operative duration, blood loss, hospitalization period, oncological outcomes, and cost, providing a comprehensive insight into the future of robotic-assisted colorectal surgery.

EXPERT OPINION

Robotic surgery significantly improves patient outcomes, including shorter postoperative recovery times and effective cancer resection margins. However, challenges faced with these platforms include longer intraoperative times, arm clashing, the need for bedside assistance, and cost. Nevertheless, with the evolution toward managing more complex rectal cancer cases and more challenging dissection planes, the need for robotic platforms will only grow.

Prediction of Basic Robotic Competence for Robotic Visceral Operations Using the O-Score within the "Robotic Curriculum for Young Surgeons" (RoCS)

INTRODUCTION

Surgical residency programs lack structured assessments of robotic surgery. The validated O-Score is an assessment tool for tracking robotic operative proficiency consisting of 9 items on a 5 point Likert scale. Surgical autonomy is one comprehensive binary item. This study aimed to establish a benchmark for the number of procedures and the O-Score sum score to achieve surgical autonomy in robotic visceral procedures.

MATERIAL AND METHODS

This single-center prospective pilot cohort study assessed robotic procedures between 2020 and 2023. Bedside and console assistance performances were analyzed separately based on the O-Score and the calculated total numerical sum of the individual item values of the O-Score. Bedside assistance was conducted for upper gastrointestinal, hepatopancreatobiliary, and colorectal procedures, whereas console assistance referred to either one of the three areas. The study participants included inexperienced robotic surgeons who were evaluated by 2 robotic experts.

RESULTS

In total, 273 procedures were included in this study. For 13 bedside assistants, 273 O-Score assessments were identified, and 62 O-Score assessments for six console assistants. Surgical autonomy was achieved in 50.9% for bedside assistance and in 11.3 % for assistance at the robotic console. Surgical autonomy was positively correlated with the O-Score sum for bedside (p = < 0.001) and console assistance (p = 0.004). The positive prediction of surgical autonomy for bedside (console) assistance ranged from 74% (60%) to 93% (100%), correlated with a range of the O-Score sum between 37 (37) and 40 (40) and a robotic caseload between 19 (17) and 33 (24) procedures.

CONCLUSIONS

A significant improvement in the basic robotic performance was observed. Benchmarks regarding number of cases and O-Score sum were established for bedside assistance regardless of the type of visceral robotic operation. Currently, data on console assistance are limited. Monitoring robotic operative skills and skill progression is feasible in daily routine using the O-Score and O-Score sum.

Modified Delphi Procedure to Achieve Consensus for the Concept of a National Curriculum for Minimally Invasive and Robot-assisted Surgery in Germany (GeRMIQ)

The rapid development of minimally invasive surgery (MIS) and robot-assisted surgery (RAS) requires standardized training to ensure high-quality patient care. In Germany, there is currently a lack of a standardized curriculum that teaches these specialized skills. The aim of this study is to find a consensus for the development of a nationwide curriculum for MIS and RAS with the subsequent implementation of the consented content.A modified Delphi process was used to reach consensus among national experts in MIS and RAS. The process included a literature review, an online survey and an expert conference.All 12 invited experts participated in the survey. They primarily achieved consensus on 73% and secondarily within the expert conference on 95 out of 122 questions (77.9%). The preference for a basic curriculum as a foundation on which specialized modules can build on was particularly clear. The results support the development of an integrated curriculum for MIS and RAS that includes step-by-step training from theoretical knowledge via e-learning modules to practical skills in dry lab simulations and in the OR. Emphasis was placed on the need to promote clinical judgment and decision making through targeted assessment during the learning curve to ensure effective application of learned skills in clinical practice. There was also a consensus that training content must be aligned with learners' skill acquisition using objective performance assessments in line with the principle of proficiency-based progression (PBP). The continuous updating of the curriculum to keep it up to date with the latest technology was considered essential.The study underlines the urgent need for a standardized training curriculum for MIS and RAS in Germany in order to increase patient safety and improve the quality of surgical care. There is broad expert consensus for the implementation of such a curriculum. It aims to ensure a contemporary and internationally competitive uniform quality of training and to increase the attractiveness of surgical training.

The impact of standardized robotics course training during colorectal surgery fellowship on post-training practice: a survey of graduates

The Association of Program Directors for Colon and Rectal Surgery (APDCRS) has sponsored a standardized robotics course for colorectal and minimally invasive surgery fellows since 2011. The study objective was to assess the impact of the APDCRS-sponsored course on surgical approaches adopted by young colorectal surgeons before, during, and after fellowship. An internet-based survey was administered to 2014-2022 ACGME-accredited colorectal surgery program graduates. Study variables were summarized using frequencies and proportions. Survey response rate was 43.2%. Laparoscopic and robotic volumes were consistently higher than open and hand-assist laparoscopic volumes over the study period. About 70.0% of fellows performed ≥ 20 laparoscopic cases before 2017, and over 80% had experience with ≥ 20 laparoscopic cases during/after 2017. An increasing trend of performing ≥ 20 robotic colorectal cases during fellowship was observed (before 2017: 75.0%, 2018-2019: 76.9%, and 2021-2022: 84.8%). Multivariate logistic regression analysis showed that higher robotic volume (≥ 25 colorectal cases) during general surgery residency increased odds of performing ≥ 50 robotic cases during fellowship (OR: 4.38, 95% CI 0.88, 26.1). Higher robotic volumes during fellowship correlated with higher robotic volumes in the first year of post-fellowship practice. 88.6% of respondents agree (21.0%) or strongly agree (67.6%) that the APDCRS robotics training course met expectations, and 83.8% agree or strongly agree that the course prepared them for post-graduate robotics practice. The APDCRS-sponsored robotics training course met expectations and prepared colorectal surgery fellows for adopting the robotic approach after graduation, with the majority of respondents reporting that they utilize robotics in their post-graduation colorectal practice.

IMRA/SRS Delphi consensus on international standards for common core components of robotic surgical training design

Robotic surgery has expanded internationally at pace. There are multiple local robotic training pathways but there is inconsistency in standardisation of core common components for curricula internationally. A framework is required to define key objectives that can be implemented across robotic training ecosystems. This Delphi consensus aimed to provide recommendations for core considerations in robotic training design across diverse training environments internationally. A literature search was performed and an international steering committee (AG, KL, JW, HM, TC) proposed key components for contemporary robotic training design and a modified Delphi approach was used to gather stakeholder opinion. The outcomes were then discussed at a face-to-face international expert consensus at the IMRA educational session at the Society of Robotic Surgery (SRS) meeting and final voting was conducted on outstanding items. Stakeholders included robotic surgeons, proctors, trainees and robotic surgical training providers. There was consensus achieved in 139 statements organised into 15 themes. There was 100% agreement that standardised themes in robotic curricula may improve patient safety. Key take-home messages include-training curricula should be multiplatform, non-technical skills are an important component of a robotic curriculum as well as console and bedside skills, clinically relevant performance metrics should be used for assessment where available, the reliance on cadaveric and live animal models should be reduced as high-fidelity synthetic models emerge, and stepwise component training is useful for advanced procedural training. These consensus recommendations are intended to guide design of fit for purpose contemporary robotic surgical curricula. Integration of these components into robotic training pathways internationally is recommended.

The training pathway for residents: 'Robotic Curriculum for young Surgeons' (RoCS) does not impair patient outcome during implementation into clinical routine

The "Robotic Curriculum for young Surgeons" (RoCS) was launched 03/2020 to address the increasing importance of robotics in surgical training. It aims to provide residents with foundational robotic skills by involving them early in their training. This study evaluated the impact of RoCS' integration into clinical routine on patient outcomes. Two cohorts were compared regarding the implementation of RoCS: Cohort 1 (before RoCS) included all robot-assisted procedures between 2017 and 03/2020 (n = 174 adults) retrospectively; Cohort 2 (after RoCS) included all adults (n = 177) who underwent robotic procedures between 03/2020 and 2021 prospectively. Statistical analysis covered demographics, perioperative parameters, and follow-up data, including mortality and morbidity. Subgroup analysis for both cohorts was organ-related (upper gastrointestinal tract (UGI), colorectal (CR), hepatopancreaticobiliary system (HPB)). Sixteen procedures were excluded due to heterogeneity. In-hospital, 30-, 90-day morbidity and mortality showed no significant differences between both cohorts, including organ-related subgroups. For UGI, no significant intraoperative parameter changes were observed. Surgery duration decreased significantly in CR and HPB procedures (p = 0.018 and p < 0.001). Estimated blood loss significantly decreased for CR operations (p = 0.001). The conversion rate decreased for HPB operations (p = 0.005). Length of hospitalization decreased for CR (p = 0.015) and HPB (p = 0.006) procedures. Oncologic quality, measured by histopathologic R0-resections, showed no significant changes. RoCS can be safely integrated into clinical practice without compromising patient safety or oncologic quality. It serves as an effective training pathway to guide robotic novices through their first steps in robotic surgery, offering promising potential for skill acquisition and career advancement.

[The new continuing education regulations-A challenge for visceral surgery : Results of a survey among DGAV members and solution strategies of the Young Surgeons]

BACKGROUND

The new competency-based further training regulations (nWBO) for surgical training have been adopted by all German state medical associations.

METHODS

From May to June 2023 the Young Surgeons' Working Group (CAJC) conducted an anonymous online survey among the 5896 members of the German Society for General and Visceral Surgery (DGAV).

OBJECTIVE

The survey aimed to assess expectations regarding the nWBO and to develop strategies for enhancing surgical training.

RESULTS

With 488 participants (response rate 8.3%) the study is representative. The respondents consisted of 107 continuing education assistants (WBA 21.9%), 69 specialist physicians, and 188 senior physicians (specialist physicians 14.1% and senior physicians 38.5%), as well as 107 chief physicians (21.9%). The majority worked in regular care providers (44%), followed by maximum care providers (26.8%) and university clinics (20.1%). Only 22% considered the required operative spectrum of the new medical specialist training regulations (nWBO) to be realistic. Half of the respondents believed that full training in their clinic according to the new catalog will no longer be possible and 54.6% considered achieving the target numbers in 6 years to be impossible or state that they can no longer train the same number of continuing education assistants (WBAs) in the same time frame. Endoscopy (17.1-18.8%), fundoplication (15.4-17.7%) and head and neck procedures (12.1-17.1%) were consistently mentioned as bottlenecks across all levels of care. Rotations for balance were reported to be already established or not necessary in 64.7%. In 48% it was stated that the department had established the partial steps concept. The importance of a structured training concept was considered important by 85% of WBAs, compared to 53.3% of chief physicians (CÄ). If a structured training concept was present in the department, the achievability of the target numbers was significantly assessed more positively in the univariate analysis. In the multivariate analysis, male gender and the status of "habilitated/professor" were independent factors for a more positive assessment of the nWBO. Objective certification of training was considered important by 51.5%.

CONCLUSION

Concerns surround the nWBO and the sentiment is pessimistic. Additional requirements and hospital reforms could exacerbate the situation. Collaboration and rotations are crucial but still insufficiently implemented. Quality-oriented certification could enhance the quality of training.

[Evidence, Availability and Future Visions in Simulation in General and Visceral Surgery]

Practice makes perfect - a saying that everyone has certainly heard. Surgeons of all levels of training can demonstrably practice to some extent on simulators. This training outside the operating theatre and independent of patients makes sense, both ethically and financially. Although the effectiveness of simulation in surgery has been proven several times, simulation training is not a mandatory part of surgical specialist training in Germany. Simulation covers a very wide range in terms of application, effort and costs. This review is intended to give an overview of the systems and their areas of application and the target group. The focus lies on the commonly available systems and possible advantages and disadvantages. Practical skills are in the foreground and all three pillars of general and visceral surgery - conventional techniques, laparoscopy and robotics - are taken into account. However, simulators alone do not achieve cost-benefit effectiveness. The full potential of such an investment can only be exploited with a site-specific, structured training concept in which simulation training according to the post-graduate year and appropriate allocation to surgeries in the operating room are closely interlinked. It should always be possible to train basic skills on site. The significant additional costs for complex simulation systems are possible, depending on the financial resources, or should be purchased in a network or for national courses. The techniques of immersive virtual reality in combination with artificial intelligence and deformation algorithms will certainly play a decisive role for the future of simulation, whereby the use of the available systems must be a primary goal. The integration of simulation into specialist training should be striven for, not least in order to justify the costs.