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Published on: May 20, 2018
Using Ratio of Economy of Motion to Assess Entrustment of Trainees During Robotic Colorectal Surgery
Usama Waqar1, Mishal Gillani1, Manali Rupji2
1Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Introduction:
Surgical training requires intermittent assessments of trainee entrustment (TE). There is currently no universally accepted objective method to quantify TE during surgery. We investigate using objective performance indicators, automated metrics calculated from robotic systems data, to offer unbiased insights regarding TE. In this feasibility study, we identified differences in TE during dual-console robotic procedures (DCPs).
Methods:
Endoscopic videos synchronized to robotic systems data were captured during 87 colorectal DCPs. The ratio of economy of motion (rEOM), defined as the path length of the trainee's robotic arms divided by that of the attending surgeon's, was used to assign each step visit to either the attending or the trainee. TE was compared for 11 general surgery chief residents and four colorectal surgery fellows. Summary statistics were used to describe the pattern along with T-test or Wilcoxon Sum-Rank test for comparisons.
Results:
The objective performance indicator data were collected during 73 robotic proctectomies (RPs) and 14 robotic right colectomies (RRCs). A total of 2662 surgical step visits were analyzed. Trainees performed a total of 810/2662 (30.4%) step visits, 722/2413 (29.9%) during RPs and 88/249 (35.4%) during RRCs. Fellows performed more step visits than residents during RP (median proportion of steps per procedure 36.4% [IQR: 23.3-48.3%] versus 25.7% [18.6-34.6%], respectively; P = 0.035). Compared to the first half, fellows exhibited greater entrustment during the latter half of the academic year during all DCPs (2nd half: 38.9% [36.4-51.5%] versus 1st half: 25.0% [14.3-39.1%]; P < 0.001) and RPs (2nd half: 39.4% [36.4-51.5%] versus 1st half: 29.1% [14.3-39.8%]; P = 0.008). Residents experienced greater entrustment during RRCs compared to RPs (36.7% [30.8-57.9%] versus 25.7% [18.6-34.6%]; P = 0.022). No differences in TE were seen when comparing procedures for benign versus malignant disease or with different attendings.
Conclusions:
We objectively quantified TE during DCPs using rEOM. This supports the feasibility of utilizing rEOM to track.
