Towards development and validation of an intraoperative assessment tool for robot-assisted radical prostatectomy training: results of a Delphi study.

Christopher Morris,Edward D Matsumoto,Bobby Shayegan,Jen Hoogenes

doi:10.1590/s1677-5538.ibju.2016.0420

Abstract

ABSTRACTIntroduction As urology training shifts toward competency-based frameworks, the need for tools for high stakes assessment of trainees is crucial. Validated assessment metrics are lacking for many robot-assisted radical prostatectomy (RARP). As it is quickly becoming the gold standard for treatment of localized prostate cancer, the development and validation of a RARP assessment tool for training is timely.Materials and methods We recruited 13 expert RARP surgeons from the United States and Canada to serve as our Delphi panel. Using an initial inventory developed via a modified Delphi process with urology residents, fellows, and staff at our institution, panelists iteratively rated each step and sub-step on a 5-point Likert scale of agreement for inclusion in the final assessment tool. Qualitative feedback was elicited for each item to determine proper step placement, wording, and suggestions.Results Panelist’s responses were compiled and the inventory was edited through three iterations, after which 100% consensus was achieved. The initial inventory steps were decreased by 13% and a skip pattern was incorporated. The final RARP stepwise inventory was comprised of 13 critical steps with 52 sub-steps. There was no attrition throughout the Delphi process.Conclusions Our Delphi study resulted in a comprehensive inventory of intraoperative RARP steps with excellent consensus. This final inventory will be used to develop a valid and psychometrically sound intraoperative assessment tool for use during RARP training and evaluation, with the aim of increasing competency of all trainees.

Highlights

As urology training shifts toward competency-based frameworks, the need for tools for high stakes assessment of trainees is crucial
We report on a study to address the first stage in this process, which comprises the development of an inventory of procedural robot-assisted radical prostatectomy (RARP) steps and sub-steps as defined by a panel of expert RARP surgeons via a modified Delphi process
We recruited a panel of expert RARP surgeons external to our institution to participate in a Delphi study to evaluate and edit the initial inventory, with the goal of developing a final inventory of steps and sub-steps for RARP

Summary

Introduction

As urology training shifts toward competency-based frameworks, the need for tools for high stakes assessment of trainees is crucial. Conclusions: Our Delphi study resulted in a comprehensive inventory of intraoperative RARP steps with excellent consensus This final inventory will be used to develop a valid and psychometrically sound intraoperative assessment tool for use during RARP training and evaluation, with the aim of increasing competency of all trainees. Health care regulatory bodies in the United States, Canada, and Europe are revising curricula with a new focus on what trainees should know in order to be deemed competent [1,2,3] With this shift, the need for valid, reliable, and feasible assessment tools exists; there is a paucity in many surgical specialities. While its anatomic technique has been well- described by Menon and colleagues since its initiation in 2000, ibju | Assessment tool for robotic prostatectomy training with their most recent report in 2012 [4], reliable objective metrics for trainee evaluation of RARP have not been established

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