Incorporating a Detailed Case Log System to Standardize Robotic Colon and Rectal Surgery Resident Training and Performance Evaluation

• Published in: Journal of surgical education 2019-07, Vol.76 (4), p.1022-1029
• Main Authors: Martin, Rachel, Hsu, June, Soliman, Mark K., Bastawrous, Amir L., Cleary, Robert K.
• Format: Article
• Language: English
• Subjects: Case log; Colorectal; Minimally invasive; Patient Care; Practice-Based Learning and Improvement; Residency training; Robotic; Robotic course; Systems-Based Practice
• ISSN: 1931-7204; 1878-7452
• DOI: 10.1016/j.jsurg.2018.12.011

•This detailed standardized case log system provides the opportunity for comprehensive assessment of resident experience that allows preparation for robotic colon and rectal surgery after fellowship.•Console time increases for residents reporting greater than 10 cases.•The detailed standardized colon and rectal surgery resident case log system allows critical assessment of teaching methods that may impact dynamic course changes. This study was designed to evaluate a novel case log used as part of a standardized robotic colon and rectal surgery resident training program. This observational study describes a detailed procedure log developed to standardize training of residents in robotic colorectal surgery. The procedure log tracks resident total case numbers and execution of specific steps of eleven colorectal procedures. Case log data were accumulated and analyzed to assess resident progress. The study includes colon and rectal surgery residents during the 2016-2017 academic year. The national Colon and Rectal Surgery Robotic Training Program was developed and implemented during the 2010-2011 academic year in response to increasing adoption of robotic-assisted colorectal surgery. This program evolved to include online modules, dry lab exercises, simulation and cadaveric courses. Forty of 93 residents in 54 colon and rectal surgery programs participated in the case log system and the comprehensive training program. Residents participated as console surgeon in an average of 28 cases (range 1-115). Sixty-five percent of participating residents performed ≥20 complex colorectal cases as console surgeon. Of the 1080 operations entered, the three most frequently performed procedures were low anterior resections (n = 360, 33.3%), sigmoid resections (n = 172, 15.9%), and right colectomies with intracorporeal anastomosis (n = 138, 12.8%). Residents with 10 or more robotic cases had a 27% increase in cases as console surgeon and a 28% decrease in cases completed as bedside assistant. Experience and progression to the console varied by resident and by program. This detailed standardized case log system provides comprehensive assessment of resident experience that allows preparation for a robotic colon and rectal surgery practice after fellowship. As adoption of the robotic approach for colon and rectal cases continues to increase, novel methods that evaluate teaching methods and resident progress warrant further study.