Table I.
— Recommendations for a standardised educational programme in robot assisted gynaecological surgery: elements that reached 80–100% agreement on the Google form survey using the Delphi process.
| No. | Question/Answer | Consensus |
|---|---|---|
| 0. Curriculum – General Agreement | ||
| 1 | Q: Do you agree that a standardised robotic training curriculum for gynaecology will be advantageous to robotic training? | A standardised robotic training curriculum for gynecology will be advantageous to robotic training (100%). |
| 1. Qualification | ||
| Trainer & Trainee | ||
| 2 | Q: Experienced surgeons are exempt from completing the advanced procedural training assessment. But should learn about the basic training in new robotic systems, if they are using a new system? | Experienced surgeons are exempt from completing the advanced procedural training assessment; but they should learn about the basic training in new robotic systems, if they are using a new system (100%). |
| 3 | Q: Experienced surgeons should still study and be tested on the advanced robotic curriculum? | 50%; failed |
| 4 | Q: What is the minimum number of cases that a trainee should be mentored/proctored by an experienced trainer before they are independent surgeons? | The minimum number of cases that a trainee should be mentored/proctored by an experienced trainer before they are independent surgeons is 10 cases (80%). |
| 5 | Q: Should trainers/proctors be assessed and certified? | Trainers/proctors should be assessed and certified (100%). |
| 6 | Q: Should surgeons continue to report their outcomes after ‘certification’ with a standardised reporting template? | 60%; failed |
| 7 | Q: Should training centers be assessed and accredited via a recognised society? | Training centers should be assessed and accredited via a recognized society (100%). |
| 8 | Q: Should training centers be accredited related to case volume in the specialty via a recognised society? | Training centers should be accredited related to case volume in the specialty via a recognized society (80%). |
| 9 | Q: Should training centers be accredited related to the expertise of the trainers and the case volume in the robotic hospital affiliated with the training centre. If so how many cases/year are required? | Training centers should be accredited related to the expertise of the trainers and a case volume of >100 cases /year in the robotic hospital affiliated with the training centre (90%). |
| Reporting | ||
| 10 | Q: Components of a standard reporting template should include which components? | Components of a standard reporting template should include patient specific details (80%), comorbidities (80%), BMI (80%), operation details (80%), length of stay (80%), pre-operative staging (80%), operation time (90%), pathological staging(80%, readmission rate (80%), Clavien-Dindo (80%). |
| 2. Course/ Content of Curriculum | ||
| 11 | Q: Should the curriculum be divided into stages? | The curriculum should be divided into stages (90%). |
| Basic Training | ||
| 12 | Q: The basic robotic curriculum should include which parts/stages (can tick multiple answers as required) | Basic robotic curriculum should include baseline evaluation (90%), e-learning module (online access to information) (80%), simulation based training (100%), robotic theatre (bedside) observation (90); team simulation (90%). |
| 13 | Q: Baseline evaluation should include which parts/stages (can tick multiple answers as required). | Baseline evaluation should include VR simulation (90%) and written knowledge test (80%). |
| 14 | Q: E-learning should include which elements for basic training (can tick multiple answers as required) |
E-learning should include designated elements for basic training: Information on patient selection (100%), Information on port placement (100%), How to dock the robot cart (100%), Trouble shooting (100%), Link to FRS (80%), Theatre team efficiencies (100%), Non-technical skills (90%), Standardized emergency management (90%) |
| 15 | Q: The required operating room observation should be: | The required operating room observation should be case number dependent (90%). |
| 16 | Q: Basic simulation training should include: | Basic simulation training should include VR simulation (100%), Dry lab training (100%, Wet-lab training (90%). |
| 17 | Q: Trainees should pass the basic training before commencing the advanced training? | Trainees should pass the basic training before commencing the advanced training (90%). |
| Advanced Training | ||
| 18 | Q: Advanced robotic training should include? | Advanced robotic training should include e-learning on index procedures with video demonstration (100%), access to video library (100%), simulation training (90%), modular console training (90%), transition to full training (100%), final evaluation (90%). |
| 19 | Q: Advanced e-learning should include: | Advanced E-learning should include modular (stepwise) approach (100%), information on patient selection and preparation (100%), port placement (90%), non-technical skills training (90%), trouble shooting (100%), emergency scenario management information (100%), list of additional equipment that should be available in theatre (90%). |
| 20 | Q: Non-technical skills training should include. | 70%; failed |
| 21 | Q: Team training should include. | Team Training should include emergency scenarios (80%), team decision making (80%), bedside assistance (90%), docking (90%) and patient turnaround (80%). |
| 3. Structure of Curriculum | ||
| Target Groups | ||
| 22 | Q: Robotic curriculum training should take into account the experience of the different target groups to include (can tick multiple boxes) | Robotic curriculum training should take into account the experience of residents (100%), fellows (100%), robot naïve (100%), nurses (90%), lap surgeons (90%). |
| 23 | Q: Do you agree that there should be a common approach for basic robotic skills training with a similar pathway across subspecialty groups? | Agreement that there should be a common approach for basic robotic skills training with a similar pathway across subspecialty groups (90%). |
| Course/Sequence | ||
| 24 | Q: Is a stepwise approach (modular training) to an index procedure advantageous to training? | A stepwise approach (modular training) to an index procedure is regarded advantageous (100%). |
| 25 | Q: Is an index procedure, which should be mastered within a given period of time, necessary? | An index procedure mastered within a given period of time is necessary (80%). |
| 26 | Q: If so, do you agree that for benign gynecology a suitable index procedure would be? | A suitable index procedure for benign gynecology would be benign hysterectomy (90%). |
| 27 | Q: If so, do you agree that for gynecology oncology a suitable index procedure would be? | A suitable index procedure for gynecological oncology would be pelvic lymphadenectomy (80%). |
| 28 | Q: Is a resident experienced trainer/proctor necessary when the trainee is proceeding to ‘transition to full procedure’ in the surgeons home institution? | A resident experienced trainer/proctor is necessary when the trainee is proceeding to “transition to full procedure” in the surgeons home institution (100%). |
| 4. Test Instruments | ||
| E-Learning | ||
| Q: Each section of the e-learning should have questions to evaluate knowledge. | Each section of the e-learning should have questions to evaluate knowledge (90%). | |
| 30 | Q: Advanced e-learning modules should be evaluated with online tests? | Advanced E-learning modules should be evaluated with online tests (100%). |
| Evaluation, Analysis | ||
| 31 | Q: Non-technical skills training should be evaluated with a scoring system? | Non-technical skills training should be evaluated with a scoring system (80%). |
| 32 | Q: Non-technical skills can be sufficiently assessed with NOTSS (Non-Technical Skills for Surgeons)? | Non-technical skills can be sufficiently assessed with NOTSS (80%). |
| 33 | Q: Would trainees benefit from validated scoring systems to provide more consistent feedback? | Trainees would benefit from validated scoring systems to provide more consistent feedback (90%). |
| 34 | Q: Should full procedure technique be evaluated with a submitted video to certified independent examiners? | Full procedure technique should be evaluated with a submitted video to certified independent examiners (80%). |
| 35 | Q: If answer to above yes, which case number should be sent for analysis and feedback? | 70%, failed |
| 36 | Q: Evaluation of videos should be completed with a validated standardised scoring system? | Evaluation of videos should be completed with a validated standardized scoring system (80%). |
| 37 | Q: Scoring systems for video analysis should include (can tick multiple boxes)? | Scoring systems for video analysis should include a combination of subjective and objective scoring systems (e.g. GEARS, OSATS, a new objective scoring system) (100%). |
| 38 | Q: How many ‘experts’ should analyse the surgery videos? | 2 experts should analyse the surgery videos (90%). |
| 39 | Q: Should video analysis and the logbook be the final evaluation step for ‘certification’? | Video analysis and the logbook should be the final evaluation step for certification (90%). |