Implementing a Robotics Curriculum in Surgery: Lessons learned from the Experts - An Interim Report.

Kristen Jogerst, M.D. 
Research Fellow in MGH Surgery General 
PGY 3
03/01/2020

How does one best train a surgical resident or fellow to become proficient in robotic surgery? What are the best methods for surgical educators to use if they are hoping to teach trainees robotic surgery for the first time? Is simulation necessary? Will this training framework change overtime as general surgery and surgical residencies change?  Does a surgical educator’s frame of reference (based on their own training background) affect how they approach these training questions? To answer all of these questions, my research team, led by Dr. Denise Gee, and I developed a phone interview guide to interview experts within robotic surgery and surgical education. We interviewed experts across academic and community general surgery, gynecological surgery, and urology. We are completing this qualitative investigation using a framework analysis. We received approval from our IRB, achieved group consensus on our refined interview guide after several practice interviews, and have 29 out of our 32 intended interviews done. We have completed interviews with robotic surgical experts and surgical educators across four strata: academic general surgery (10), gynecological surgery (9), Urology (6), and community general surgery (4).

Emerging themes and representative quotes from our team's
preliminary analysis of the semi-structures interviews

While the study is ongoing, our team has already learned a lot about what experts think it takes to build an excellent robotic surgical training program as well as pitfalls they wish they would have knew prior to implementing curricula at their home institutions. Give my research participants are all clinical faculty and surgical experts, many of them are quite busy. I have been extremely appreciative of how willing these experts have been to give of their time. One of the major obstacles to completing qualitative research studies is the same barrier faced by many surgical education projects: time. Logistically many of my phone interviews would get cancelled, delayed, or unexpectedly rescheduled for early morning hours, late nights, or weekends.  However, these scheduling flexibilities have been worth it, as I have been privileged to gain decades worth of surgical education wisdom, all within a few short months. If anyone reading this has ever attempted a qualitative research study with rigorous methodology, I have much more respect for you after the last few months. I also now know the importance of having a backup recorder and how valuable an accurate transcriptionist can be. The rewards and wisdom imparted from the unique constructivist research perspective makes qualitative investigations worthwhile. However, those rewards must be earned and one should expect the research study timeline to take at least double the original timeline estimates. I am thankful for my co-investigator and second transcript coder, Dr. Taylor Coe. Our preliminary analyses and exciting findings would not have emerged without her diligent efforts and late nights of editing and refining our codebook. This project has taught me that when building new curricula or exploring challenging research questions, it is important to consult the experts and surround yourself with the wisdom and experience of other researchers and surgical educators.

Through these hard efforts, we have already learned that building a successful robotic surgery curriculum requires 5 emerging themes: access, investment/ buy-in, relinquishing control, evaluation, and progressive OR integration (Figure 1). We have several more interviews to complete to finalize our framework analysis and compare across the four strata. In addition to completing the final interviews, finishing our coding of the remaining transcripts using our refined codebook, and writing up our framework analysis, I am happy to report our research team

Excited to present our work at the annual meeting for the
Association of Program Directors in Surgery in Seattle
this Spring

will also have the opportunity to present our findings at the Association of Program Directors in Surgery (APDS) annual meeting in Seattle this April (Figure 2). In addition to sharing our lessons learned during Surgical Education Week, our research team plans to submit a final manuscript following the national meeting in May. We are thankful for the support and resources from the Centers of Expertise Medical Education Research Grant and look forward to sharing our final analysis with you later this spring/ summer.