Does quality assured eLearning provide adequate preparation for robotic surgical skills;A prospective, randomized and multi-center study

ABSTRACT

Introduction & Objectives: After the onset of the COVID-19 pandemic there was a precipitous rush to implement virtual and online learning strategies in surgery and medicine. In response there appears to be a precipitous rush to implement virtual and online learning strategies in surgery and medicine which many educators (particularly in industry) appear to believe can mitigate or supplant the necessity of skills laboratory training. It is therefore essential to have a robust and evidence-based understanding of this premise and to evaluate whether this approach is sufficient and adequate for learning basic robotic surgical skills and to prepare individuals to perform a basic surgical robotic task. Materials & Methods: A prospective, randomized and multi-center study 47 participants were matched and randomized into 4 groups who underwent proficiency based progression (PBP) eLearning, eLearning without benchmarks, traditional lectures and learning from peer-reviewed published manuscripts describing the suturing, knot tying and task assessment metrics. Afterwards the PBP group had skills training under COVID secure conditions. Results: The primary outcome was the percentage of trainees who demonstrated the quantitatively defined proficiency benchmark after didactic learning. (i.e., 5-Procedure Steps completed, <10 Errors and 0 = Critical Errors). Figure 1a-c shows that none of the trainees in this study demonstrated all three proficiency benchmarks (Procedure Steps p<0.001 – 0.000;Errors, p=0.403 – 0.001;Critical Errors, 0.016 – 0.001) (Figure 1a-c). After six hands-on training trials and ~ 3 hours training all PBP trained participants met all three proficiency benchmarks. Figure 1a-c. The mean and 95% CI of procedure Steps, Errors and Critical Errors made by the four groups of trainees on the robotic surgery vesico-urethral anastomosis model relative to the proficiency benchmark for each performance metric. Also shown are how far off the proficiency benchmark performance was. (Figure Presented) Conclusions: Although better than traditional learning strategies, quality assured online learning is insufficient preparation for basic robotic surgical skills. Medicine in general but surgery and procedure-based medicine specifically would be imprudent to be overly optimistic about how effective quality assured online learning is without skills lab. training.