Editorial Comment for Wiener et al.

This retrospective study determined the time required by urology residents to effectively complete a computer-based robotic surgery skills training program. These educators have previously determined construct validation of the specific skill tasks they used on the da Vinci skills simulator for this curriculum.

Development of psychomotor skills is facilitated using a spaced sequential method of practice. ¹ Distributing 10 hours of robot skill practice over five 2-hour sessions is much more effective than one 10-hour block of training time. This is helpful information for urology training programs establishing a robotic surgery skills training curriculum. The “passing” score for the skill task performances was based on expert surgeon performance scores. A more rigorous method of assessment would be to create expert, robotic surgeon-determined criteria of an acceptable skill performance and specify errors for each skill task and in particular those that constitute “failure.” This then creates an assessment device, such as a global evaluative assessment of robotic skills, which can be used in a computer-based simulator and for video review of surgeon performance as in crowd-sourcing assessment of technical skills (CSATS). ²

A prospective evaluation of the curriculum would enhance the validity of these preliminary observations. In addition, the development of an expert-derived assessment device would allow more rigorous comparison of simulated robotic skill task performance and trainee robotic operative performance to establish the much needed predictive validity of this curriculum.

It should be noted that although this training curriculum is performed on the clinical robot simulator, it still requires one-on-one instruction and oversight by a fellowship trained robotic surgeon. This may be a challenge for some training programs to duplicate. Using CSATS for the assessment of these technical skills may help to eliminate the need for the expert robotic surgeon at training sessions. Educators will be curious for information on how the residents who failed to effectively complete their assigned skill task requirements are remediated. It takes an additional 2 to 4 hours of simulator practice for these delinquent residents, but details of specific teaching techniques are lacking. These slower-to-learn residents might benefit from CSATS feedback of their skill performance. ³