The development of a robotic gynaecological surgery training curriculum and results of a delphi study

Thomas Ind,Nahid Gul,Esther Moss,Matthew Wood,Aemn Ismail

doi:10.1186/s12909-020-1979-y

Abstract

BackgroundTechnology for minimal access surgery is rapidly progressing in all surgical specialities including Gynaecology. As robotic surgery becomes established in increasing numbers of hospitals, there is no set curriculum for training in robotic gynaecological surgery or the assistant role in use in the UK. The purpose of this study was to determine a list of competencies that could be used as the basis of a core robotic gynaecological surgery curriculum, to explore its acceptability and the level of interest in undertaking training in robotics among obstetrics & gynaecology (O&G) trainees.MethodsA four-round Delphi study was conducted using members and associates of British & Irish Association of Robotic Gynaecological Surgeons (BIARGS). In Round 1 respondents were asked to propose standards that could be used in the curriculum. In the following three rounds, the respondents were asked to score each of the standards according to their opinion as to the importance of the standard. Items that scored a mean of 80% or above were included in the final proposed curriculum. Following this, a national survey was conducted to explore the interest among O&G trainees in undertaking a formal robotic training for the first assistant and console surgeon roles.ResultsThe items proposed were divided into three separate sections: competencies for a medical first assistant; competencies for a console surgeon; continued professional development for trained console surgeons. From the national survey; 109 responses were received of which 60% were interested in undertaking a formal training for the first assistant role, and 68% are expressing interest in training for the console surgeon role.ConclusionUndertaking a Delphi exercise to determine a core gynaecological robotic training curriculum has enabled consensus to be achieved from the opinions of BIARGS members/associates. There is interest among O&G trainees at all levels of training to gain experience and develop their skills in robotic surgery by undertaking a formal training in robotic surgery at both the first assistant and console surgeon level.

Highlights

Technology for minimal access surgery is rapidly progressing in all surgical specialities including Gynaecology
We investigated whether the Obstetrics & Gynaecology (O&G) trainees in the United Kingdom (UK) have had exposure to robotics during their time in training, whether this is an area on interest to gain skills on in the future and if there is interest in developing an accreditation for a medical first assistant role
54% of the participants were of the view that the trainee should achieve competency in performing the procedure as determined by the proctor as well as performing a minimum of 15 cases under direct supervision before independent practice. 57% of participants thought that the supervising surgeon should be a trained proctor and 63% of participants believed that all surgeons should have to perform each new procedure under direct supervision until competency is achieved

Summary

Introduction

Technology for minimal access surgery is rapidly progressing in all surgical specialities including Gynaecology. As robotic surgery becomes established in increasing numbers of hospitals, there is no set curriculum for training in robotic gynaecological surgery or the assistant role in use in the UK. Jon Einarsson, the president of the American Association of Gynaecologic Laparoscopists (AAGL) stated that a 90% minimal access surgery (MAS) hysterectomy rate is a realistic goal [3]. This is supported by less than 1% abdominal hysterectomy rate in one of the UK’s National Health Service (NHS) hospitals with RS use in selected cases [4]. The European Association of Urology (EAU) and the Society of European Robotic Gynaecological Surgery (SERGS) have published robotic training curriculum for interested trainees [12]. Proficiency in robotic surgery is not currently a component of specialty training in Gynaecology in the UK and the trainees to date who have gained experience have done so as part of subspeciality training (typically gynaecological oncology) or as senior clinical fellows

Objectives

Methods

Results

Conclusion