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Ann Surg. 2019 Jan 31. doi: 10.1097/SLA.0000000000003220. [Epub ahead of print]

Proving the Effectiveness of the Fundamentals of Robotic Surgery (FRS) Skills Curriculum: A Single-blinded, Multispecialty, Multi-institutional Randomized Control Trial.

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Department of Surgery, University of Washington Medical Center, Seattle, WA.
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
Department of Ob/Gyn, Drexel University College of Medicine, Institute of Surgical Excellence, Philadelphia, PA.
Florida Hospital Nicholson Center, University of Central Florida College of Medicine, Celebration, FL.
Department of Surgery, St. Mary's Hospital, Imperial College, London, UK.
EndoCAS Simulation Center, University of Pisa, Pisa, Italy.
Andersen Simulation Center, Madigan Army Medical Center, Tacoma, WA.
Center for Education, Simulation and Innovation, Hartford Hospital, Hartford, CT.
Penn Medicine Clinical Simulation Center, Philadelphia, PA.
Department of Colon and Rectal Surgery, Lahey Health and Medical Center, Burlington, MA.
National and Kapodistrian University of Athens, Athens, Greece.
Houston Methodist Hospital, Methodist Institute for Technology, Innovation, and Education, Houston, TX.
USF Health Center for Advanced Medical Learning and Simulation, Tampa, FL.
Lehigh Valley Health Network, Allentown, PA.
Department of Surgery, Surgical Education and Activities Lab, Duke University Medical Center, Durham, NC.
Technology Enhanced Learning, ASSERT Centre, College of Medicine and Health, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland.
Faculty of Life and Health Sciences, Ulster University, Magee Campus, Londonderry, United Kingdom.


MINI: Question: Is the Fundamentals of Robotic Surgery (FRS) proficiency-based progression curriculum effective for teaching basic robotic surgery skills?


In an international multi-institutional, multispecialty, blinded, randomized control trial, implementation of the FRS skills curriculum using various simulation platforms led to improved performance of surgical trainees on a transfer test compared with controls.Meaning: The FRS is an effective simulation-based course for training to proficiency on basic robotic surgery skills before surgeons apply those skills clinically.


To demonstrate the noninferiority of the fundamentals of robotic surgery (FRS) skills curriculum over current training paradigms and identify an ideal training platform.


There is currently no validated, uniformly accepted curriculum for training in robotic surgery skills.


Single-blinded parallel-group randomized trial at 12 international American College of Surgeons (ACS) Accredited Education Institutes (AEI). Thirty-three robotic surgery experts and 123 inexperienced surgical trainees were enrolled between April 2015 and November 2016. Benchmarks (proficiency levels) on the 7 FRS Dome tasks were established based on expert performance. Participants were then randomly assigned to 4 training groups: Dome (n = 29), dV-Trainer (n = 30), and DVSS (n = 32) that trained to benchmarks and control (n = 32) that trained using locally available robotic skills curricula. The primary outcome was participant performance after training based on task errors and duration on 5 basic robotic tasks (knot tying, continuous suturing, cutting, dissection, and vessel coagulation) using an avian tissue model (transfer-test). Secondary outcomes included cognitive test scores, GEARS ratings, and robot familiarity checklist scores.


All groups demonstrated significant performance improvement after skills training (P < 0.01). Participating residents and fellows performed tasks faster (DOME and DVSS groups) and with fewer errors than controls (DOME group; P < 0.01). Inter-rater reliability was high for the checklist scores (0.82-0.97) but moderate for GEARS ratings (0.40-0.67).


We provide evidence of effectiveness for the FRS curriculum by demonstrating better performance of those trained following FRS compared with controls on a transfer test. We therefore argue for its implementation across training programs before surgeons apply these skills clinically.

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