Impact of a Robotic Inanimate Training Curriculum vs Virtual Reality Alone on Surgical Resident Technical Skill and Stress

Abstract

Background: As usage of robotic surgery increases, so does development of residency robotic training programs. Although virtual reality (VR) training is well established, the role of biotissue in robotic training for surgical residents remains understudied. We hypothesized that adding an inanimate curriculum would improve technical skills beyond VR alone, improving resident confidence and reducing stress.

Study design: From 2019 to 2023, PGY3 general surgery residents completed the 2-week robotic curriculum using the da Vinci system. A pretest or posttest design was used. First, the residents completed a pretest of 4 VR exercises, scored 0% to 100%, and 3 inanimate box trainer exercises, graded via modified Objective Structured Assessment of Technical Skills (mOSATS; range 6 to 30). After completing 23 VR modules, residents repeated the same assessments. They then completed daily box trainer drills simulating common robotic procedures, followed by a final posttest. All residents answered cognitive assessment surveys to assess mental burden.

Results: 32 residents completed the curriculum. After the VR curriculum, VR (159% vs 229%, p < 0.0001) and mOSATS scores (15.5 vs 20.9, p < 0.0001) increased, and time to completion (1,128 vs 773 seconds, p < 0.0001) decreased. After the conclusion of the 2-week curriculum, performance further improved. From first to second posttest, mOSATS scores increased (20.9 vs 25.8, p < 0.0001) and time to completion decreased (773 vs 484 seconds, p < 0.0001). Residents reported feeling more relaxed, with decreased mental demand and exertion. Notably, residents self-reported improved performance.

Conclusions: The addition of an inanimate biotissue curriculum significantly improved resident technical performance over VR alone. Additionally, completion of the curriculum decreased resident stress using the robot.