Department of Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA.
Surg Endosc. 2024 Oct;38(10):6008-6016. doi: 10.1007/s00464-024-11039-8. Epub 2024 Aug 1.
A growing importance has been placed on development of trainee robotic surgical skills through simulation curricula and intraoperative experience. However, few studies have examined how console case type impacts learning outcomes. We sought to evaluate how intraoperative coaching and resident autonomy differ based on the use of a single- versus dual-console robot.
Robotic single- and dual-console cases from February to September 2023 at a single institution were included. Faculty and trainees wore microphones to capture audio during the case. Pre/post surveys were administered, which included metrics on faculty coaching based on the Wisconsin Surgical Coaching Rubric (WiSCoR) and on trainee technical performance based on the Global Evaluative Assessment of Robotic Skills (GEARS). Statistical analysis of survey data was performed using SPSS. Audio from cases was coded by 2 researchers with a deductive approach using WiSCoR as a framework.
Data were collected for 7 (38.9%) single and 11 (61.1%) dual-console cases across 9 case types from 4 surgical specialties. Chi-square analysis demonstrated no significant difference in percentage of case trainee spent in the operating surgeon role based on trainee level or console case type. Independent t-tests showed no significant difference in trainee autonomy, trainee performance, or faculty coaching scores based on console case type. Trainees rated faculty highest in WiSCoR Domains 1 (sharing responsibility) and 3 (providing constructive feedback). Qualitative analysis showed that for single-console cases, Domain 4 (goal setting) was most represented (34.0% of comments), while for dual-console cases, Domain 1 was most represented (37.0% of comments).
Qualitative analysis highlights that despite similar survey-based faculty ratings across domains, coaching on self-reflection (Domain 2) is infrequently done, highlighting an opportunity for improvement in this area of coaching during robotic surgery.
通过模拟课程和术中经验，越来越重视培养学员的机器人手术技能。然而，很少有研究探讨控制台类型如何影响学习成果。我们旨在评估使用单控制台与双控制台机器人对术中指导和学员自主性的影响有何不同。
纳入 2023 年 2 月至 9 月在一家机构进行的机器人单控制台和双控制台病例。教师和学员在手术过程中佩戴麦克风以捕捉音频。在病例进行前后进行了问卷调查，其中包括基于威斯康星州手术指导量表（WiSCoR）的教师指导指标和基于机器人技能综合评估量表（GEARS）的学员技术表现指标。使用 SPSS 对调查数据进行了统计分析。使用 WiSCoR 作为框架，由 2 名研究人员对病例音频进行了演绎式编码。
共纳入 9 种手术类型的 7 例（38.9%）单控制台病例和 11 例（61.1%）双控制台病例，涉及 4 个外科专业。卡方分析表明，学员在手术医师角色中的占比与学员级别或控制台类型无关。独立 t 检验表明，控制台类型与学员自主性、学员表现或教师指导评分均无显著差异。学员在 WiSCoR 领域 1（分担责任）和 3（提供建设性反馈）方面对教师的评价最高。定性分析表明，对于单控制台病例，领域 4（设定目标）的占比最高（34.0%的评论），而对于双控制台病例，领域 1 的占比最高（37.0%的评论）。
定性分析强调，尽管在各领域的基于调查的教师评价相似，但在机器人手术中很少进行自我反思（领域 2）方面的指导，这突显了在该领域指导方面进行改进的机会。
