Development of a procedure specific and skill based robotic-assisted surgical training program for residents: Delphi study identifying key steps and required skill levels for teaching the low-anterior resection

Introduction: The rapid expansion of robotic-assisted surgery (RAS) necessitates comprehensive training of residents. Historically, training programs focused on teaching essential technical skills, neglecting procedure-specific proctor courses. Establishing a step-by-step framework for procedural training promises a uniform, safe, and efficient teaching process. This study aims to identify the key steps and complexities crucial for teaching the robotic-assisted low-anterior resection (RA-LAR) effectively and thereby enhancing the national standardized RAS training program for surgical residents in the Netherlands. 

Methods: A list of operation phases and procedural key steps to perform the RA-LAR was compiled, together with a description of four skill levels. Using the Delphi method, experts rated the procedural key steps on a Likert scale and granted them one of four skill levels. The operation phases were queried through multiple-choice questions. Round one, two, and four consisted of online questionnaires; round three, an online meeting. 

Results: Consensus was achieved after four rounds. Of the 21 invited experts, 13 participated in the first round (62%) and 11 in the second round (52%). From these 11 experts, 9 (82%) completed the third and fourth rounds (100%). High internal consistency among experts was indicated in Delphi round one by Cronbach’s alpha values of 0.94 for procedural key steps and 0.86 for skill levels. 11 operation phases, 27 procedural key steps, and corresponding skill levels were established for the RA-LAR. 

Conclusion: For the RA-LAR, national consensus was reached on the operation phases, procedural key steps, and their corresponding skill levels. A teaching framework is now ready for testing efficacy in training of surgical residents in robotic-assisted surgery.