Perception vs Reality: Examining Trainee Participation and Handoffs in Robotic General Surgery

Abstract

INTRODUCTION: Despite expansion of robotic surgery, resident participation during robotic cases remains poorly characterized. The aim of this study was to compare perceptions of case participation and handoffs between trainees and faculty against objective robotic metrics. METHODS: Post-case assessments evaluating trainee participation and intra-operative handoffs were distributed to faculty and trainees following case conclusion. Metrics including percent active control time (%ACT)—defined as percent of trainee console time spent actively manipulating robotic instruments—and handoff counts between dual consoles were reviewed from the robotic platform. Wilcoxon and intra-class correlation tests were applied. RESULTS: From December 2021-January 2022, 20 robotic cases with matched trainee/faculty assessments were included (Table 1). On subset analysis, reliability between trainee-reported and objective %ACT ranged from “moderate” to “excellent” (ICC = 0.915, 95% CI 0.743-0.972). Reliability between faculty-reported and objective %ACT ranged from “good” to “excellent” (ICC = 0.954, 95% CI 0.868-0.985). Mean difference between trainee-reported and objective %ACT vs faculty-reported and objective %ACT was significant (mean -6.5 vs 2.2, p = 0.0078). There was no significant difference in reported handoff counts, however, the groups reported aligned handoff reasoning in only 53% of cases, most often due to pedagogical takeover or graded autonomy. There was no significant difference in reported case difficulty or educational effectiveness between groups. Table 1. - Robotic Case Series Demographic Information Case type Cases by trainee level Cholecystectomy 6 (30%) PGY2 1 (5%) Gastric bypass 6 (30%) PGY3 3 (15%) Inguinal hernia 4 (20%) PGY4 11 (55%) Hiatal hernia 4 (20%) PGY5 2 (10%) Fellow 3 (15%) Total 20 20 CONCLUSION: In this pilot case series, faculty more reliably and accurately estimated trainee robotic case participation. Trainees underestimated their case participation on average compared to objective metrics. Further studies must investigate the foundation of poor trainee case confidence and faculty-trainee handoff misalignment in robotic surgery.