Altok Muammer, Achim Mary F, Matin Surena F, Pettaway Curtis A, Chapin Brian F, Davis John W
Department of Urology, MD Anderson Cancer Center, Houston, TX.
Department of Urology, MD Anderson Cancer Center, Houston, TX.
Urol Oncol. 2018 Jan;36(1):13.e19-13.e25. doi: 10.1016/j.urolonc.2017.08.028. Epub 2017 Sep 28.
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.
随着现代泌尿外科住院医师和机器人辅助手术进修培训向标准化课程（理论教学、模拟操作练习和手术辅助）发展，需要额外的工具来评估手术台上的表现。在2006年我们开展机器人项目之初，我们建立了一个基于时间和质量的评估项目，并旨在将这些数据整合为一套简单的自我评估指标。
采用我们机器人辅助根治性前列腺切除术（RARP）的索引程序，我们前瞻性地收集了10年间6名教员外科医生和94名学员（43名泌尿肿瘤学进修医生和51名泌尿外科住院医师）的2215例病例数据。手术步骤分为11个连贯步骤，指标包括完成时间和使用6级评分系统的质量。时间指标被整合为四分位数用于基准比较。
学员完成每个步骤的中位时间比工作人员高15%至120%（P<0.001）。通过汇总学员和工作人员的结果，可以用基于四分位数的时间指标展示每个步骤。为了获得高成功率，学员执行的步骤经过精心挑选，在我们类似李克特量表的评分中，超过95%的病例评分为4至5分。没有评为0级（非常差）的病例，1级（多个技术错误）和2级（无法完成但无安全问题）的病例很少（<1%）。
RARP培训可以用基于时间的指标进行评估，该指标允许与大量学员和工作人员的经验进行基于四分位数的比较。随着学员在轮转中取得进步，这些基准可以帮助确定是需要更多关注基本步骤还是推进到更高级步骤。
