Poster4-02: COMPARING INTERMEDIATE LEARNER AND EXPERT THORACIC SURGERY SCORES FROM ROBOTIC SIMULATION EXERCISES: NO SIGNIFICANT DIFFERENCES
Adrienne Jarocki1, David C Rice2, Michael S Kent3, Daniel S Oh4, Jules Lin1, Rishindra M Reddy1; 1University of Michigan, 2MD Anderson, 3Beth Israel Deaconess, 4Intuitive Surgical
Introduction: Simulators for laparoscopy and robotics are increasingly being used to train surgeons and assess their competency related to credentialing. We hypothesized that expert surgeons would score higher than intermediate learners in simulation exercises in overall scores and that some components of the score would better differentiate these levels of surgeons.
Methods: Senior cardiothoracic trainees with limited robotic but significant laparoscopic experience and expert robotic thoracic surgeons participating in a thoracic cadaver robotic course were evaluated on three Davinci (Xi) simulations (suture sponge, energy switching, and thread the rings). Scores were broken down into separate components (economy of ,motion, time to completion, instrument collision, excessive instrument force, drops, missed targets, instruments out of view, instrument force, and master workspace range) and analyzed by t-test for significant differences.
Results: 21 experts and 17 early leaners participated. Experts were faculty surgeons with 2-10 years of robotic experience and annual case volume of 30-150 robotic cases. All intermediate learners had performed <20 robotic cases but had completed general surgery residency and Fundamentals of Laparoscopic Surgery. Overall scores did not have a statistically significant difference in any exercise between groups. There were no significant differences between groups in any component for the suture sponge. Intermediate learners did show a significant increase in instrument collisions in the other two simulations compared to experts (energy 1.41 vs 0.48, p=0.022, rings 1.59 vs 0.38, p=0.008). Faculty had a shorter time to completion in energy switching (85.5 sec vs 105.2 sec, p=0.036). Faculty did worse in instrument out of view in all three simulations, though it only reached significance in the thread the rings (4.18 vs 1.8, p=0.043). Experts had the lowest coefficient of variation in economy of motion scores compared to all other metrics and had less variation than intermediate learners in all exercises.
Results: These simulation exercises do not appear to separate intermediate learners from experts. Hence, the use of simulation exercises for credentialing has to be thoughtfully considered. Instrument out of view should not be an included measurement because it may confound the comparison of overall scores between experts and intermediate learners.