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Research from MedStar Health Research Institute examining a new technique to evaluate surgical trainees could mean faster mastery of robot-assisted procedures.
As surgical technology becomes more complex, the process by which we train and evaluate surgeons must also advance to keep up. A multi-institutional study from MedStar Health Research Institute has demonstrated a new technique to objectively assess trainee performance during robotic lung surgery, removing evaluator bias and assisting residents in learning faster.
Robot-assisted lung surgery enables doctors to perform complex procedures through smaller incisions. This minimally invasive technique uses miniature instruments attached to robotic arms, guided by a tiny camera, to remove tumors or part of the lung.
Using robotic surgery equipment requires special training and intense evaluation of every step of a procedure. But current training assessments are global—they evaluate overall performance and are not able to focus as much on how well each specific step was performed.
For example, the Global Evaluative Assessment of Robotic Skills (GEARS) tool assesses performance using a five-point scale across six parameters. It is the standard for surgical evaluation but doesn’t produce detailed data about learner performance and where they need to improve. Global assessments also do not account for the human biases of evaluators, such as preferred surgical techniques or even their mood at that moment- all of which influence peer-based evaluations.
Delivering the best patient outcomes is directly tied to surgical expertise and experience. To evaluate residents from a purely analytical perspective, we needed something more precise than a global assessment.
MedStar Health Research Institute, in conjunction with their clinical partners, has designed a new, objective, real-time measuring approach to gather rich data that will help genuinely evaluate—and more quickly build upon—the robotic surgery skills of our thoracic residents.
And we believe this is just the beginning of a new wave of evaluation technology in surgical robotics training.
Assessing the details matters.
Every action the learner takes during robotic surgery training is translated through a machine. We gathered these previously unmeasured data by connecting a new data recording device that captures every part of the procedure.
By analyzing the robot’s movements at every step, complex surgeries can be broken down into small tasks. To assess our evaluation, 46 residents completed a robot-assisted lobectomy—removal of part of the lung—on pigs. Data recorders captured and analyzed data on 12 distinct tasks, each correlated with bleeding incidents during the procedure.
To arrive at a bias-free analysis, resident performance on each task was then compared to the exact moment in surgeries performed by experts. The result was an established relationship between specific steps and the patient’s outcomes.
Through this new method, residents can receive optimal training to master surgical procedures faster and more precisely.
A new evaluation tool across disciplines.
We believe this landmark paper in thoracic surgery education has the potential to change how we evaluate surgical residents in multiple fields. For example, a score of 90% on a global assessment is impressive, but the missing 10% could be critical to patient outcomes. Providing actionable reviews gives evaluators insights to guide trainees on improving during the next simulation or procedure.
We’re working now to prepare for future studies in a multidisciplinary setting to demonstrate that these techniques are broadly applicable. Then we’ll aim to study clinical outcomes to ensure patients receive top-quality care.
We hope to make this technology available to early adopters in thoracic surgery fellowships because we believe it can significantly contribute to how the next generation of surgeons will learn.
This vital work is a reaffirmation of MedStar Health’s commitment to educating clinicians who are surgeon scientists, producing the best outcomes for all our patients. Research like this confirms that MedStar is on the leading edge of surgical education, providing fellows with an unparalleled depth of education as they learn to be tomorrow’s leaders in robotic surgery.
