How Long Should a Trainee Practice on a Robotic Simulator?

This is probably the most frequent question asked when people are trying to understand the impact of investing in a simulator for their robotic surgical program. Of course, there is not one answer to this question as training objectives can vary significantly depending on the trainee’s discipline, level of surgical experience, and standards set by a hospital’s robotics committee. However, regardless of the training objective, a trainee should not be judged by “how long” they have trained, but by whether training data indicates “proficiency”. However, rather than boring you with published articles on what it means to be proficient, I will share some generalized data with you that will help answer this question.

I have been able to analyze the utilization at some of our high usage centers on both dV-Trainers® and da Vinci® Skills Simulators. While the overall usage is higher on the dV-Trainer®, the utilization distribution is the same across both platforms. These systems represented 705 different users who spent over 2,600 hours on the systems.

The average utilization of the system is just under 4 hours per user. I, therefore, chose to split the users into three groups: those who spent more than 10 hours on the system, those who spent between 4 and 10 hours, and those who spent less than 4 hours.

As you can see, the vast majority of people spent less than 4 hours with approximately 1 in 4 spending less than an hour.

However, if you look at the impact on the utilization you will see that the smaller group of dedicated trainees (those that trained for more than 10 hours) dominate the total simulation usage.

How does this help answer the original questions? One interpretation is that if someone does not spend more than 4 hours on a simulator, they cannot be seen to be serious about training. If they spend over 10 hours, then they are clearly more interested in developing the right skill level. Interestingly, 10 hours is the amount of time that the Urology Department at Hartford Hospital felt was the optimum time residents should be spending on simulation based on their 2015 study (Read the full study here). The answer could therefore be, “at least 10 hours should be spent on simulation training or as long as it takes you to become proficient”.

The real answer is that it will vary by individual and will be partly based on their level of interest and their innate ability. In 2014, a paper was published by Andrea Moglia from Pisa on the innate ability that medical students might have for robotics (Read the full study here). The paper was able to show that 6.6% of the student population of 125 had a significantly higher score than the median and were as good as expert surgeons the first time they sat down on the console. At the other end, there were 11% who clearly had no aptitude at all. It should be expected that users with innate ability will require significantly less training time than the average user, but the time needed will be dependent on the curricula and the proficiency thresholds that have been set by their institutions. The time an individual will need to spend on a simulator to gain proficiency will therefore be driven by a number of factors, including their own motivations, their innate ability, and the proficiency standard set by their institution.