Validity, reliability, and predictive performance of a multi-tool competency assessment framework in a...

Structured robotic surgery curricula increasingly integrate simulation, dry lab, microsurgery and high-fidelity wet lab training, yet few studies have comprehensively evaluate how performances across these educational components relate to final proficiency in a multimodal curriculum. We aimed to evaluate the WETPROF inter-university robotic surgery diploma curriculum by analyzing relationships between theoretical knowledge, simulator performance, practical training modules and final wet lab performance, while assessing the reliability and convergent validity of the assessment instruments used throughout the program. We retrospectively analyzed prospectively collected data from 131 surgeons enrolled in the WETPROF curriculum between 2023 and 2025. Training included theoretical assessment, DvTrainer virtual reality simulation, microsurgery, GEARS-rated FRS Dome exercises and a final porcine wet lab evaluated using GEARS, ARCS and NOTSS. Internal consistency was assessed using Cronbach's alpha, convergent validity with Spearman correlations, group comparisons using non-parametric tests, and multivariable regression models were used to identify predictors of simulator progression and final wet lab performance. The wet lab assessment instruments demonstrated excellent internal consistency (Cronbach's α=0.975) and very strong convergent validity (ρ=0.85-0.89; all p<0.001). Baseline theoretical knowledge was not associated with either simulator or wet lab performance. Prior robotic experience significantly improved simulator progression, particularly DvTrainer performance (effect size r=0.525), whereas its influence on final wet lab performance was limited. DvTrainer curriculum score was independently predicted by GEARS FRS Dome, microsurgery performance and GEARS Wet Lab (R²=0.480). In contrast, wet lab performance was only weakly explained by demographic characteristics (R²=0.156), with DvTrainer score emerging as the only independent external predictor (β=+0.220, p=0.016). These findings indicate that simulator progression and wet lab performance represent complementary dimensions of surgical competence. The WETPROF curriculum provides a coherent multimodal framework for robotic surgery training. The excellent reliability and convergent validity of the assessment instruments support their use within competency-based education. Although theoretical knowledge and prior experience contribute little to final wet lab performance, progression through the simulation curriculum is associated with better technical performance in a high-fidelity environment, supporting the educational value of a progressive simulation-based pathway before clinical practice.