Nicholas Raison1,2, Thomas Wood1, Oliver Brunckhorst1, Takashige Abe1, Talisa Ross1, Ben Challacombe3, Mohammed Shamim Khan1, Giacomo Novara4, Nicolo Buffi5, Henk Van Der Poel6, Craig McIlhenny7, Prokar Dasgupta8, Kamran Ahmed1. 1. Division of Transplantation Immunology & Mucosal Biology, Faculty of Life Sciences & Medicine, Guy's Hospital, MRC Centre for Transplantation, King's College London, 5th Floor Tower Wing, London, SE1 9RT, UK. 2. Department of Urology, The London Clinic, London, UK. 3. Department of Urology, Guy's and St Thomas' NHS Trust, London, UK. 4. Department of Urology, University of Padua, Padua, Italy. 5. Department of Urology, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy. 6. Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands. 7. Department of Urology, Forth Valley Royal Hospital, Larbert, UK. 8. Division of Transplantation Immunology & Mucosal Biology, Faculty of Life Sciences & Medicine, Guy's Hospital, MRC Centre for Transplantation, King's College London, 5th Floor Tower Wing, London, SE1 9RT, UK. prokar.dasgupta@kcl.ac.uk.
Abstract
BACKGROUND: Non-technical skills (NTS) are being increasingly recognised as vital for safe surgical practice. Numerous NTS rating systems have been developed to support effective training and assessment. Yet despite the additional challenges posed by robotic surgery, no NTS rating systems have been developed for this unique surgical environment. This study reports the development and validation of the first NTS behavioural rating system for robotic surgery. METHODS: A comprehensive index of all relevant NTS behaviours in robotic surgery was developed through observation of robotic theatre and interviews with robotic surgeons. Using a Delphi methodology, a panel of 16 expert surgeons was consulted to identify behaviours important to NTS assessment. These behaviours were organised into an appropriate assessment template. Experts were consulted on the feasibility, applicability and educational impact of ICARS. An observational trial was used to validate ICARS. 73 novice, intermediate and expert robotic surgeons completed a urethrovesical anastomosis within a simulated operating room. NTS were tested using four scripted scenarios of increasing difficulty. Performances were video recorded. Robotic and NTS experts assessed the videos post hoc using ICARS and the standard behavioural rating system, NOn-Technical Skills for Surgeons (NOTSS). RESULTS: 28 key non-technical behaviours were identified by the expert panel. The finalised behavioural rating system was organised into four principle domains and seven categories. Expert opinion strongly supported its implementation. ICARS was found to be equivalent to NOTSS on Bland-Altman analysis and accurately differentiated between novice, intermediate and expert participants, p = 0.01. Moderate agreement was found between raters, Krippendorff's alpha = 0.4. The internal structure of ICARS was shown to be consistent and reliable (median Cronbach alpha = 0.92, range 0.85-0.94). CONCLUSION: ICARS is the first NTS behavioural rating system developed for robotic surgery. Initial validation has shown it to be an effective and reliable tool. Implementation of ICARS will supported structured training and assessment of NTS within the robotic surgical curriculum.
BACKGROUND: Non-technical skills (NTS) are being increasingly recognised as vital for safe surgical practice. Numerous NTS rating systems have been developed to support effective training and assessment. Yet despite the additional challenges posed by robotic surgery, no NTS rating systems have been developed for this unique surgical environment. This study reports the development and validation of the first NTS behavioural rating system for robotic surgery. METHODS: A comprehensive index of all relevant NTS behaviours in robotic surgery was developed through observation of robotic theatre and interviews with robotic surgeons. Using a Delphi methodology, a panel of 16 expert surgeons was consulted to identify behaviours important to NTS assessment. These behaviours were organised into an appropriate assessment template. Experts were consulted on the feasibility, applicability and educational impact of ICARS. An observational trial was used to validate ICARS. 73 novice, intermediate and expert robotic surgeons completed a urethrovesical anastomosis within a simulated operating room. NTS were tested using four scripted scenarios of increasing difficulty. Performances were video recorded. Robotic and NTS experts assessed the videos post hoc using ICARS and the standard behavioural rating system, NOn-Technical Skills for Surgeons (NOTSS). RESULTS: 28 key non-technical behaviours were identified by the expert panel. The finalised behavioural rating system was organised into four principle domains and seven categories. Expert opinion strongly supported its implementation. ICARS was found to be equivalent to NOTSS on Bland-Altman analysis and accurately differentiated between novice, intermediate and expert participants, p = 0.01. Moderate agreement was found between raters, Krippendorff's alpha = 0.4. The internal structure of ICARS was shown to be consistent and reliable (median Cronbach alpha = 0.92, range 0.85-0.94). CONCLUSION: ICARS is the first NTS behavioural rating system developed for robotic surgery. Initial validation has shown it to be an effective and reliable tool. Implementation of ICARS will supported structured training and assessment of NTS within the robotic surgical curriculum.
Entities:
Keywords:
Assessment tool; Curriculum; Education; Non-technical skills; Robotic surgery; Training
Authors: Thomas Charles Wood; Nicholas Raison; Shreya Haldar; Oliver Brunckhorst; Craig McIlhenny; Prokar Dasgupta; Kamran Ahmed Journal: J Surg Educ Date: 2016-12-20 Impact factor: 2.891
Authors: L Hull; C Bicknell; K Patel; R Vyas; I Van Herzeele; N Sevdalis; N Rudarakanchana Journal: Eur J Vasc Endovasc Surg Date: 2016-05-25 Impact factor: 7.069
Authors: James Brewin; Jessica Tang; Prokar Dasgupta; Muhammad S Khan; Kamran Ahmed; Fernando Bello; Roger Kneebone; Peter Jaye Journal: BJU Int Date: 2015-03-07 Impact factor: 5.588
Authors: Rebecca A Fisher; Prokar Dasgupta; Alex Mottrie; Alessandro Volpe; Mohammed S Khan; Ben Challacombe; Kamran Ahmed Journal: Int J Surg Date: 2014-12-06 Impact factor: 6.071
Authors: Erika Palagonia; Elio Mazzone; Geert De Naeyer; Frederiek D'Hondt; Justin Collins; Pawel Wisz; Fijs W B Van Leeuwen; Henk Van Der Poel; Peter Schatteman; Alexandre Mottrie; Paolo Dell'Oglio Journal: World J Urol Date: 2019-08-19 Impact factor: 4.226
Authors: Anthony Manuguerra; Charles Mazeaud; Nicolas Hubert; Pascal Eschwège; Mathieu Roumiguié; Julia Salleron; Jacques Hubert Journal: Surg Endosc Date: 2020-09-23 Impact factor: 4.584
Authors: Tara N Cohen; Jennifer T Anger; Falisha F Kanji; Jennifer Zamudio; Elise DeForest; Connor Lusk; Ray Avenido; Christine Yoshizawa; Stephanie Bartkowicz; Lynne S Nemeth; Ken Catchpole Journal: J Patient Saf Date: 2022-07-07 Impact factor: 2.243
Authors: Peter Hertz; Kim Houlind; Jan Jepsen; Lars Bundgaard; Pernille Jensen; Mikkel Friis; Lars Konge; Flemming Bjerrum Journal: Surg Endosc Date: 2021-10-27 Impact factor: 3.453
Authors: Cora Griffin; Abdullatif Aydın; Oliver Brunckhorst; Nicholas Raison; Muhammad Shamim Khan; Prokar Dasgupta; Kamran Ahmed Journal: World J Urol Date: 2019-09-17 Impact factor: 4.226
Authors: Alexander J W Beulens; Willem M Brinkman; Evert L Koldewijn; Ad J M Hendrikx; Jean Paul A van Basten; Jeroen J G van Merriënboer; Henk G Van der Poel; Chris H Bangma; Cordula Wagner Journal: Eur Urol Open Sci Date: 2020-07-03