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Proving the Effectiveness of the Fundamentals of Robotic Surgery(FRS) Skills Curriculum

Satava, Richard M. MD, FACS*; Stefanidis, Dimitrios MD, PhD; Levy, Jeffrey S. MD; Smith, Roger PhD§; Martin, John R. MD; Monfared, Sara MD; Timsina, Lava R. PhD; Darzi, Ara Wardkes MD; Moglia, Andrea PhD||; Brand, Timothy C. MD#; Dorin, Ryan P. MD**; Dumon, Kristoffel R. MD††; Francone, Todd D. MD‡‡; Georgiou, Evangelos MD PhD§§; Goh, Alvin C. MD; Marcet, Jorge E. MD||||; Martino, Martin A. MD##; Sudan, Ranjan MD***; Vale, Justin MBBS||; Gallagher, Anthony G. PhD†††,‡‡‡

A Single-blinded, Multispecialty, Multi-institutional Randomized Control Trial

Mini Question
Is the Fundamentals of Robotic Surgery (FRS) proficiency-based progression curriculum effective for teaching basic robotic surgery skills?

Findings: In an international multi-institutional, multispecialty, blinded, randomized control trial, implementation of the FRS skills curriculum using various simulation platforms led to improved performance of surgical trainees on a transfer test compared with controls.

Meaning
The FRS is an effective simulation-based course for training to proficiency on basic robotic surgery skills before surgeons apply those skills clinically.

Objective
To demonstrate the noninferiority of the fundamentals of robotic surgery (FRS) skills curriculum over current training paradigms and identify an ideal training platform.

Summary Background Data
There is currently no validated, uniformly accepted curriculum for training in robotic surgery skills.

Methods
Single-blinded parallel-group randomized trial at 12 international American College of Surgeons (ACS) Accredited Education Institutes (AEI). Thirty-three robotic surgery experts and 123 inexperienced surgical trainees were enrolled between April 2015 and November 2016. Benchmarks (proficiency levels) on the 7 FRS Dome tasks were established based on expert performance. Participants were then randomly assigned to 4 training groups: Dome (n = 29), dV-Trainer (n = 30), and DVSS (n = 32) that trained to benchmarks and control (n = 32) that trained using locally available robotic skills curricula. The primary outcome was participant performance after training based on task errors and duration on 5 basic robotic tasks (knot tying, continuous suturing, cutting, dissection, and vessel coagulation) using an avian tissue model (transfer-test). Secondary outcomes included cognitive test scores, GEARS ratings, and robot familiarity checklist scores.

Results
All groups demonstrated significant performance improvement after skills training (P < 0.01). Participating residents and fellows performed tasks faster (DOME and DVSS groups) and with fewer errors than controls (DOME group; P < 0.01). Inter-rater reliability was high for the checklist scores (0.82–0.97) but moderate for GEARS ratings (0.40–0.67).

Conclusions
We provide evidence of effectiveness for the FRS curriculum by demonstrating better performance of those trained following FRS compared with

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