Editorial Comment for White et al.

Building on the sentinel article by Birkmeyer and associates, ¹ the article by White and colleagues represents important work—helping our profession address assessment of technical skills for robotic surgical procedures using crowd-sourcing. Increasingly transparent surgical outcomes are undeniably tied to our technical skills. The development and assessment of standards and programs for credentialing technical skills has been slowly gaining momentum. Roadblocks to the implementation of such programs historically has consisted of the assurance of accuracy (validity), concerns over cost, logistics, political pushback by those who fear a loss of autonomy, and a lack of direction as to who is ultimately “responsible.”

This article addresses the first three of the four roadblocks with an elegant solution leveraging private-sector social-networking technology. The authors showed that crowds agreed with experts on the assessment of basic robotic skills, but in greater numbers (validity), for less money (cost), and in a shorter amount of time (logistics). The unknown lies in determining which learning objectives, within the complex list of technical skills involved in surgery, will be valid with this method of assessment.

For basic skills, abstract tasks and even isolated steps of procedures, I believe this approach will prove to be invaluable across surgical skills and disciplines and should be examined for nontechnical skills as well (team communication). I suspect, however, that some of the subtle, yet important aspects of surgical skill, such as recognition of tissue planes and common/uncommon variants of anatomy, may present challenges for layman crowds to discern.

Either way, our profession needs to invest time and effort on the front end into clearly defining, “What it is we need to measure” and “What it means to be competent and/or proficient” to ultimately allow for innovative technologic solutions such as Crowd-Sourced Assessment of Technical Skill to help us all be better surgeons and best serve our patients.