BRIDGING THE GAP IN ROBOT-ASSISTED SURGICAL TRAINING: A SYSTEMS APPROACH

Abstract

The central goal of any surgical residency training program is to prepare physicians and surgeons for independent practice within an outcome-based, peer-reviewed system. Despite significant reforms by the American Council of Graduate Medical Education (ACGME) to establish competency-based education (CBE) models, there is severe variability in the quality of robotic-assisted surgery (RAS) training for surgical residents, leading to disparities in their preparedness for independent practice. This dissertation examines urology residents' perceived training and assessment variability, focusing on their confidence and competence in RAS procedures. Using Bronfenbrenner’s Ecological Systems Theory (EST) as the theoretical framework, this study analyzes the multi-layered influences on residents' training experiences within an urban academic medical center. Data were collected from 16 faculty and 16 residents through surveys, revealing three pivotal themes for refining RAS training: enhancing structured training programs, increasing simulation-based training, and integrating early exposure to RAS techniques. Key findings indicate that residents report diverse experiences and varying levels of exposure to RAS procedures, with significant gaps in mentorship and feedback. Both residents and faculty recognize the importance of tailored training programs, but discrepancies exist in perceptions of intraoperative danger, time efficiency, and skill acquisition rates. Identified barriers include limited autonomy for residents, competing institutional priorities, and the need for extra time for effective teaching. The study underscores the need for standardized and comprehensive RAS training programs to ensure consistent, high-quality education. Addressing identified barriers and aligning training approaches with resident and faculty expectations can enhance residents' preparedness, competence, and confidence in robotic surgery, ultimately improving patient outcomes and advancing the field of urology. This dissertation provides actionable recommendations for developing structured training pathways, incorporating diverse educational tools, and fostering a cohesive educational environment. This research aims to equip future surgeons with the necessary skills to excel in advanced minimally invasive procedures by bridging the gap in RAS training