Credentialing and Patient Safety in Robotic Gynecologic Surgery: Changes over the Last Nine Years

Abstract

<h3>Study Objective</h3> To assess how credentialing standards and perceptions of safe use of robotic surgery in gynecology have changed over time. <h3>Design</h3> Two anonymous online surveys conducted in 2012 and 2021. <h3>Setting</h3> ACGME approved residency programs. <h3>Patients or Participants</h3> Trainees (residents and fellows) and attending physicians. <h3>Interventions</h3> Survey. <h3>Measurements and Main Results</h3> A total of 367 physicians responded to the survey; 265 in 2012 and 102 in 2021. Distributions of responses were compared using the Fisher exact test and percentage-based statistics. 89% of 2021 respondents compared to 30% of 2012 respondents reported having the robot at their institution for >5 years. The average number of robotic cases performed increased over time, with only 19% performing >5 cases monthly in 2012 compared to 35% in 2021. 100% of attending respondents in 2021 reported having formalized credentialing processes for robotic surgery compared to 70% in 2012. The percentage of attendings performing bedside assisting prior to console work increased from 46% to 79%. Attendings report of institutional minimum case number requirements to maintain robotic credentials increased from 27% to 90%, with the majority (76%) reporting 10-20 cases needed annually. When asked about beliefs about the number of cases needed for surgical independence, trainees and attendings reported higher numbers in 2021; the percentage reporting >20 cases were required for independence increased from 58% to 93% and 29% to 70%, respectively. Trainees and attendings increased their rate of reporting that attendings are always fully independent and competent (52% to 69% and 51% to 68%, respectively) and decreased their rate of reporting that those doing robotic cases lacked the skills to do so safely (54% to 6% and 30% to 21%, respectively). Notably, nearly a quarter of attending surgeons still reported they had colleagues who lacked skills to consistently perform safe robotic surgery in 2021. <h3>Conclusion</h3> Expansion of credentialing processes over time correlated with improved confidence in surgeon skills.