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REVIEW ARTICLE
Year : 2021  |  Volume : 48  |  Issue : 3  |  Page : 121-123

Inclusion of competencies pertaining to robotic surgery in the medical curriculum: Scope, need, and considerations


1 Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

Date of Submission07-Apr-2021
Date of Acceptance28-May-2021
Date of Web Publication28-Dec-2021

Correspondence Address:
Dr. Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.jss_31_21

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  Abstract 


Robotic surgery has started to emerge as one of the effective and sought-after approaches in the field of surgery in the last couple of decades. The quick adoption and propagation of robotic surgery is primarily because of the numerous benefits attributed to the same. The purpose of the current review was to explore the inclusion of competencies pertaining to robotic surgery within the undergraduate and postgraduate medical curriculum. An extensive search of all materials related to the topic was carried out in the PubMed search engine and a total of 16 articles were selected based upon the suitability with the current review objectives and analyzed. In the current set-up, the majority of the medical colleges don't offer much to their undergraduate or postgraduate surgical residents in terms of exposure to robotic surgery. However, considering that sooner or later, every future medical student or resident will have an encounter with a patient who has already undergone a robotic surgery or will be undergoing the same, we have to ensure formal introduction in the teaching curriculum. In conclusion, the future of robotic surgery is changing and it is finding numerous applications in different surgical streams. Acknowledging the scope of the same, as medical educators, it is our responsibility to introduce in the curriculum, provide adequate number of learning opportunities and supplement with periodic assessments for a better patient care.

Keywords: Curriculum, medical education, robotic surgery


How to cite this article:
Shrivastava SR, Shrivastava PS. Inclusion of competencies pertaining to robotic surgery in the medical curriculum: Scope, need, and considerations. J Sci Soc 2021;48:121-3

How to cite this URL:
Shrivastava SR, Shrivastava PS. Inclusion of competencies pertaining to robotic surgery in the medical curriculum: Scope, need, and considerations. J Sci Soc [serial online] 2021 [cited 2022 Aug 15];48:121-3. Available from: https://www.jscisociety.com/text.asp?2021/48/3/121/333843




  Introduction Top


Robotic surgery has started to emerge as one of the effective and sought-after approaches in the field of surgery in the last couple of decades.[1] In-fact, it is being employed in various surgical streams (viz. Urology, Gynecology, Thoracic surgery, Otorhinolaryngology, General Surgery, etc.), and even in complex surgeries, especially in nations with better health care delivery system.[1],[2] Acknowledging the scope and applicability of robotic surgery, we must accept that it will be an important approach in the future days for minimizing the sufferings of patients, and its scope will further expand in different surgical streams.[1] The purpose of the current review was to explore the inclusion of competencies pertaining to robotic surgery within the undergraduate and postgraduate medical curriculum.


  Methods Top


An extensive search of all materials related to the topic was carried out in the PubMed search engine. Relevant research articles focusing on robotic surgery during undergraduate and postgraduate medical teaching published in the period 2017 to 2021 were included in the review. A total of 18 studies similar to current study objectives were identified initially, of which, two were excluded due to the unavailability of the complete version of the articles. Overall, 16 articles were selected based upon the suitability with the current review objectives and analyzed. Keywords used in the search include robotic, robotic surgery, robotic skills, and medical education in the title alone only (viz. robotic surgery [ti]; robotic skills [ti]; robotic [ti]; robotic [ti] AND medical education [ti]). The articles published in only the English language were included for the review. The collected information is presented under the following sub-headings, namely Merits of robotic surgery, Robotic surgery and Medical Education,

Need to expose medical students to robotic surgery, Learning opportunities for medical students and residents, Simulation and robotic surgery, Utility of robotic surgery, Additional considerations, Implications for practice and Implications for research.


  Merits of robotic surgery Top


The quick adoption and propagation of robotic surgery is primarily because of the numerous benefits attributed to the same like better ergonomics, higher probability of safety of patients, relatively easier for the surgeon (viz. lesser operative time, reduced blood loss, better visualization, lesser risk of post-operative complications including infections, etc.).[2] From the patients' perspective, they tend to have shortened hospital stay, better recovery rates, cosmetic benefits due to smaller incisions, and lesser number of complications.[3] It won't be wrong to document that the utility of robots in surgical interventions is expected to increase further, with the increase in their effectiveness and engineering modifications, especially in terms of their size.[1],[2],[3],[4]


  Robotic surgery and Medical Education Top


In the current set-up, the majority of the medical colleges don't offer much to their undergraduate or postgraduate surgical residents in terms of exposure to robotic surgery.[3],[5] Even in the settings where robotic surgery curriculum is available, the content is quite diversified, variable and often is covered by means of didactic lecture.[6],[7] It is quite a significant possibility that the surgical residents complete their entire training period without being exposed to even a single robotic case. However, considering that sooner or later, every future medical student or resident will have an encounter with a patient who has already undergone a robotic surgery or will be undergoing the same, and thus it is the responsibility of the regulatory bodies to create an adequate number of learning experiences for the students or residents.[3],[4],[5]


  Need to expose medical students to robotic surgery Top


Robotic surgery has emerged as the next big thing in the field of modern surgery and this justify for the need to provide adequate number of learning opportunities.[8] We must note that as the awareness about the modality has increased over a period of time, even the patients have started to inquire about the same with higher frequency.[8],[9],[10] This calls for the need that a medical student should have a better understanding about the pros and cons of robotic surgery to help their patients to make an evidence-based decision.[1],[2],[3] The introduction to robotic surgery should be given due consideration and it has to be in the form of a formal introduction in the teaching curriculum in terms of framing a set of competencies that needs to be achieved.[5],[6],[7]


  Learning opportunities for medical students and residents Top


In case of surgical residents, they always have the provision to refine their robotic surgery skills in terms of specialist postings to centres offering robotic surgeries, but the same does not stand true with regard to medical undergraduates.[2],[3] The postgraduate surgical residents can be trained in basic robotic skills (such as patient side training and console training) as well as more complex maneuvers in a safe and step-wise manner. It is important to define the precise nature of learning experiences and the duration for the same within the entire training period.[2],[3],[4]

It will be a welcome step to incorporate some of the competencies of robotic surgery once the undergraduate medical students enter clinical years and continue the same during the internship.[1],[2],[6],[7] The rationale behind this is making them familiar about the basics of robotic surgery, so that they are not at loss while offering care to the patients who have been subjected to the same.[6],[7],[8],[9]


  Simulation and robotic surgery Top


The advancements made in the field of medical simulation has played an important role in improving the clinical skills of the medical students. The same advantages and scope can be extrapolated to the field of robotic surgery and the students can be benefited.[11],[12],[13] As a matter of fact, the available literature clearly has suggested that progress made in simulation exercises has also helped in the improvement of acquisition of robotic skills and better performance of the trainee students, both in terms of technical and non-technical attributes.[11],[12] Further, the introduction of simulation during the training period has created a number of innovative opportunities for the students to become better in their surgical skills.[13]


  Utility of robotic surgery Top


In a study done across a medical university in the United States of America, to explore the impact of robotic surgery on the performance of residents while performing herniorrhaphy and cholecystectomy, encouraging results were reported.[14] However, it was emphasized that to derive optimal benefits, there is a need to adopt a structured curriculum.[14] On a similar note, favorable results have been obtained while using robotic surgery in urology and laparoscopic procedures.[8],[11]


  Additional considerations Top


Another important consideration is the need to formally assess the framed competencies using different tools, so that the learning in residents can be effectively monitored. The planned assessments will prepare the medical students for their future role in patient care.[3] Regardless of all the merits and the scope of robotic surgery in the current health scenario, we cannot ignore the existing challenges (viz. financial constraints, non-availability across multiple settings that makes it difficult to access for medical students, technical support, opinion of teachers that students don't require exposure, etc.), that play a significant role in the universal introduction of the same.[2],[3],[4] However, we have to find a way to overcome the same and ensure that undergraduate students and postgraduate residents are exposed to robotic surgery during their training period.


  Implications for practice Top


The seamless introduction of a robotic surgery curriculum can be accomplished only with the support of the administrators, faculty members and other stakeholders. The process has to ideally begin with the willingness of the administrators to support the initiative as it will be a resource-intensive procedure. This has to follow with the introduction of a structured curriculum to clearly specify what all needs to be covered during the training period and the strategies to be adopted for the same. It will be a welcome step to adopt the Kern's six-step model for designing a de-novo curriculum in a medical school.

Further, we have to perform the curriculum mapping and this entire process will require support of the Curriculum Committee Members and the faculty members from the surgical departments. In addition, it is essential that we should explore the safety of the entire training aspects in terms of patient well-being and the institution.[15] There is always a scope to explore the cost-benefit ratio to make a well-informed decision.[15] We have to definitely give due consideration towards the available logistics and the ways in which all the students can be provided with adequate number of learning opportunities.


  Implications for research Top


Acknowledging the ground reality that the introduction of robotic competencies within the medical curriculum is a novel initiative, there is a significant scope to explore from the research angle. The planned research can focus towards identification of the various streams and the procedures wherein robotic training can be imparted to the students. At the same time, it is always possible to employ workplace-based assessment tools to assess the performance of the students. Further, we can compare the performance of the students trained via two different approaches and this can provide us critical inputs about the effectiveness of methods. Moreover, we can even plan qualitative studies to obtain the perception of teachers and students about robotic skill training and the impact it has produced in improving their performance.[16]


  Conclusion Top


In conclusion, the future of robotic surgery is changing and it is finding numerous applications in different surgical streams. Acknowledging the scope of the same, as medical educators, it is our responsibility to introduce in the curriculum, provide adequate number of learning opportunities and supplement with periodic assessments for a better patient care.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ashrafian H, Clancy O, Grover V, Darzi A. The evolution of robotic surgery: surgical and anaesthetic aspects. Br J Anaesth 2017;119:i72-84.  Back to cited text no. 1
    
2.
Sridhar AN, Briggs TP, Kelly JD, Nathan S. Training in robotic surgery-an overview. Curr Urol Rep 2017;18:58.  Back to cited text no. 2
    
3.
Naik R, Mandal I. Robotic simulation experience in undergraduate medical education: a perspective. J Robot Surg 2020;14:793-4.  Back to cited text no. 3
    
4.
Collins JW, Dell'Oglio P, Hung AJ, Brook NR. The importance of technical and non-technical skills in robotic surgery training. Eur Urol Focus 2018;4:674-6.  Back to cited text no. 4
    
5.
Hall ME, Reddy RM. Should every medical student receive exposure to robotic surgery? J Robot Surg 2017;11:375-6.  Back to cited text no. 5
    
6.
Chen R, Rodrigues Armijo P, Krause C; SAGES Robotic Task Force, Siu KC, Oleynikov D. A comprehensive review of robotic surgery curriculum and training for residents, fellows, and postgraduate surgical education. Surg Endosc 2020;34:361-7.  Back to cited text no. 6
    
7.
Nacul MP, Melani AGF, Zilberstein B, Benevenuto DS, Cavazzola LT, Araujo RLC, et al. Educational note: teaching and training in robotic surgery. An opinion of the minimally invasive and robotic surgery committee of the Brazilian college of surgeons. Rev Col Bras Cir 2020;47:e20202681.  Back to cited text no. 7
    
8.
Wang RS, Ambani SN. Robotic surgery training: Current trends and future directions. Urol Clin North Am 2021;48:137-46.  Back to cited text no. 8
    
9.
Carpenter BT, Sundaram CP. Training the next generation of surgeons in robotic surgery. Robot Surg 2017;4:39-44.  Back to cited text no. 9
    
10.
Yang K, Zhen H, Hubert N, Perez M, Wang XH, Hubert J. From dV-trainer to real robotic console: the limitations of robotic skill training. J Surg Educ 2017;74:1074-80.  Back to cited text no. 10
    
11.
Patel HRH. Simulation training in laparoscopy and robotic surgery. J Vis Surg 2017;3:177.  Back to cited text no. 11
    
12.
Bresler L, Perez M, Hubert J, Henry JP, Perrenot C. Residency training in robotic surgery: The role of simulation. J Visc Surg 2020;157:S123-9.  Back to cited text no. 12
    
13.
Azadi S, Green IC, Arnold A, Truong M, Potts J, Martino MA. Robotic surgery: the impact of simulation and other innovative platforms on performance and training. J Minim Invasive Gynecol 2021;28:490-5.  Back to cited text no. 13
    
14.
Kadakia N, Malek K, Lee SK, Lee EJ, Burruss S, Srikureja D, et al. Impact of robotic surgery on residency training for herniorrhaphy and cholecystectomy. Am Surg 2020;86:1318-23.  Back to cited text no. 14
    
15.
Madureira FAV, Varela JLS, Madureira D Filho, D'Almeida LAV, Madureira FAV, Duarte AM, et al. Model of a training program in robotic surgery and its initial results. Rev Col Bras Cir 2017;44:302-7.  Back to cited text no. 15
    
16.
Zhao B, Lam J, Hollandsworth HM, Lee AM, Lopez NE, Abbadessa B, et al. General surgery training in the era of robotic surgery: a qualitative analysis of perceptions from resident and attending surgeons. Surg Endosc 2020;34:1712-21.  Back to cited text no. 16
    




 

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  In this article
Abstract
Introduction
Methods
Merits of roboti...
Robotic surgery ...
Need to expose m...
Learning opportu...
Simulation and r...
Utility of robot...
Additional consi...
Implications for...
Implications for...
Conclusion
References

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