The application of objective clinical human reliability analysis (OCHRA) in the assessment of basic robotic surgical skills.

Abstract

Using a validated, objective, and standardised assessment tool to assess progression and competency is essential for basic robotic surgical training programmes. Objective clinical human reliability analysis (OCHRA) is an error-based assessment tool that provides in-depth analysis of individual technical errors. We conducted a feasibility study to assess the concurrent validity and reliability of OCHRA when applied to basic, generic robotic technical skills assessment. Selected basic robotic surgical skill tasks, in virtual reality (VR) and dry lab equivalent, were performed by novice robotic surgeons during an intensive 5-day robotic surgical skills course on da Vinci® X and Xi surgical systems. For each task, we described a hierarchical task analysis. Our developed robotic surgical-specific OCHRA methodology was applied to error events in recorded videos with a standardised definition. Statistical analysis to assess concurrent validity with existing tools and inter-rater reliability were performed. OCHRA methodology was applied to 272 basic robotic surgical skills tasks performed by 20 novice robotic surgeons. Performance scores improved from the start of the course to the end using all three assessment tools; Global Evaluative Assessment of Robotic Skills (GEARS) [VR: t(19) = - 9.33, p < 0.001] [dry lab: t(19) = - 10.17, p < 0.001], OCHRA [VR: t(19) = 6.33, p < 0.001] [dry lab: t(19) = 10.69, p < 0.001] and automated VR [VR: t(19) = - 8.26, p < 0.001]. Correlation analysis, for OCHRA compared to GEARS and automated VR scores, shows a significant and strong inverse correlation in every VR and dry lab task; OCHRA vs GEARS [VR: mean r = - 0.78, p < 0.001] [dry lab: mean r = - 0.82, p < 0.001] and OCHRA vs automated VR [VR: mean r = - 0.77, p < 0.001]. There is very strong and significant inter-rater reliability between two independent reviewers (r = 0.926, p < 0.001). OCHRA methodology provides a detailed error analysis tool in basic robotic surgical skills with high reliability and concurrent validity with existing tools. OCHRA requires further evaluation in more advanced robotic surgical procedures.