A decade of robot-assisted radical prostatectomy training: Time-based metrics and qualitative grading for fellows and...

As modern urology residency and fellowship training in robot-assisted surgery evolves toward standardized curricula (didactics, dry/wet-laboratory exercises, and surgical assistance), additional tools are needed to evaluate on-console performance. At the start of our robotics program in 2006, we set-up a time- and quality-based evaluation program and aim to consolidate this data into a simple set of metrics for self-evaluation.

Using our index procedure of robot-assisted radical prostatectomy (RARP), we prospectively collected data on 2,215 cases over 10 years from 6 faculty surgeons and 94 trainees (43 urologic oncology fellows and 51 urology residents). The steps of the operation were divided into 11 consistent steps, and the metrics included time to completion and quality using a 6-level grading system. Time metrics were consolidated into quartiles for benchmarking.

The median times for trainees to complete each step were 15% to 120% higher than those of the staff (P<0.001). Each step can be presented with quartile-based time metrics by pooled trainee and staff results. Steps performed by trainees were carefully chosen for a high success rate, and on our Likert-like scale were graded 4 to 5 in more than 95% of cases. There were no grade 0 (very poor) cases, and grades 1 (multiple technical errors) and 2 (could not be completed but without safety issues) were rare (<1%).

RARP training can be evaluated with a time-based metric that allows a quartile-based comparison to a large experience of trainees and staff. As a trainee progress through a rotation, these benchmarks can assist in prioritizing the need for more attention to a basic step vs. progression to more advanced steps.