Simulation-based assessment of robotic cardiac surgery skills: An international multicenter, cross-specialty trialCentral MessagePerspective
Gennady V. Atroshchenko, MD,
Emiliano Navarra, MD,
Matthew Valdis, MD, MSc, FRCS,
Elena Sandoval, MD,
Nasseh Hashemi, MD,
Stepan Cerny, MD,
Daniel Pereda, MD, PhD,
Meindert Palmen, MD, PhD,
Flemming Bjerrum, MD, PhD,
Niels Henrik Bruun, MSc,
Martin G. Tolsgaard, MD, DMSc, PhD
Affiliations
Gennady V. Atroshchenko, MD
Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark; ROCnord Robotic Centre Aalborg, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Address for reprints: Gennady V. Atroshchenko, MD, Department of Cardiothoracic Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.
Emiliano Navarra, MD
Department of Cardiac Surgery, Ospedale Sant'Andrea, “Sapienza” University of Rome, Rome, Italy
Matthew Valdis, MD, MSc, FRCS
Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Center, London, Ontario, Canada
Elena Sandoval, MD
Department of Cardiovascular Surgery, Hospital Clínic, Barcelona, Spain
Nasseh Hashemi, MD
Nordsim, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
Stepan Cerny, MD
Department of Cardiac Surgery, Na Homolce Hospital, Prague, Czech Republic
Daniel Pereda, MD, PhD
Department of Cardiovascular Surgery, Hospital Clínic, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
Meindert Palmen, MD, PhD
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
Flemming Bjerrum, MD, PhD
Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital–Herlev and Gentofte, Herlev, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Denmark
Niels Henrik Bruun, MSc
Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
Martin G. Tolsgaard, MD, DMSc, PhD
Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Denmark; Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Medicine, University of Copenhagen, Denmark
Objective: This study aimed to investigate the validity of simulation-based assessment of robotic-assisted cardiac surgery skills using a wet lab model, focusing on the use of a time-based score (TBS) and modified Global Evaluative Assessment of Robotic Skills (mGEARS) score. Methods: We tested 3 wet lab tasks (atrial closure, mitral annular stitches, and internal thoracic artery [ITA] dissection) with both experienced robotic cardiac surgeons and novices from multiple European centers. The tasks were assessed using 2 tools: TBS and mGEARS score. Reliability, internal consistency, and the ability to discriminate between different levels of competence were evaluated. Results: The results demonstrated a high internal consistency for all 3 tasks using mGEARS assessment tool. The mGEARS score and TBS could reliably discriminate between different levels of competence for the atrial closure and mitral stitches tasks but not for the ITA harvesting task. A generalizability study also revealed that it was feasible to assess competency of the atrial closure and mitral stitches tasks using mGEARS but not the ITA dissection task. Pass/fail scores were established for each task using both TBS and mGEARS assessment tools. Conclusions: The study provides sufficient evidence for using TBS and mGEARS scores in evaluating robotic-assisted cardiac surgery skills in wet lab settings for intracardiac tasks. Combining both assessment tools enhances the evaluation of proficiency in robotic cardiac surgery, paving the way for standardized, evidence-based preclinical training and credentialing. Clinical trial registry number: NCT05043064.
