Robotic-surgery training in general-surgery residency programs lacks consistency

Last Updated: 2018-12-14

By Will Boggs MD

NEW YORK (Reuters Health) - Robotic-surgery training in general-surgery residency programs varies widely in its content and documentation, according to results of a web-based survey.

"We noted a high level of interest in robotic-surgery training during surgical residency, with most (92%) of the responding programs offering some exposure and even more (95%) believing that robotic-surgery training is important during residency," Dr. Christine Dauphine from Harbor-UCLA Medical Center, in Torrance, California, told Reuters Health by email. "For such a high level of interest in this technology, it was surprising to see such a low rate of adoption of a formal training curriculum (only 67%)."

General-surgery robotic procedures nearly doubled between 2015 and 2017 in the U.S., but it remains unclear what level of robotic training general surgery residents receive, according to Dr. Dauphine and colleagues. So far, there is no widely recognized standardized robotic training curriculum, they note in The American Journal of Surgery, online November 20.

The team sent a 13-question survey to program administrators at all 277 Accreditation Counsel for Graduate Medical Education (ACGME) accredited general surgery residency programs in the U.S. to evaluate the current status of residency training and experience in robotic surgery. Only 41% of programs responded to the survey.

Of the 105 programs with resident participation in robotic surgery, 85 (84%) had residents actively operating at the console and 12 of the 16 programs with no active resident participation planned to include this opportunity within three years.

The most commonly performed cases by residents were hernia repairs and colorectal, biliary and gastric procedures. A quarter of programs also reported experience in more complex robotic cases, including esophageal, thoracic and pancreatic procedures.

Two-thirds of the programs with residents participating in robotic surgery had a formal robotic-surgery-training curriculum for residents, and 23 of the 34 programs that did not have such a curriculum endorsed plans to institute it within three years.

Nearly half of these curricula relied on industry-sponsored courses and fewer than 20% incorporated live animal or cadaver labs. The wide variation in curricula made it difficult to quantify residents' experience or assess their competency in the safe practice of robotic surgery, the researchers note.

Fewer than half (46/105, 44%) of the residency programs tracked their residents' experience with robotic surgery cases, and only 55% offered formal recognition for their residents' robotic expertise.

"Robotic surgery has an established place in general-surgery residency training," Dr. Dauphine said. "Still, our survey documented that much work needs to be done to make sure that robotic training is more standardized so that residents can document their level of competency so that it is then transferable to the next step in their careers, whether that be fellowship or clinical practice."

"At this time, there is no way to log robotic cases in the ACGME caselog system (residents/programs have to track by hand) and no way to document competence in a standardized way (each program has a different curriculum and many have none)," she said. "Residents then are forced to take an industry-led course during fellowship or when getting hospital privileges, even if they have a robust residency experience."

SOURCE: https://bit.ly/2Ce0JIe

Am J Surg 2018.