Competency-Based Education in Minimally Invasive and Robotic Colorectal Surgery

Abstract

Minimally invasive and robotic techniques have become increasingly implemented into surgical practice and are now an essential part of the foundational skills of training colorectal surgeons. Over the past 5 years there has been a shift in the surgical educational paradigm toward competency-based education (CBE). CBE recognizes that trainees learn at different rates but regardless, are required to meet a competent threshold of performance prior to independent practice. Thus, CBE attempts to replace the traditional “time” endpoint of training with “performance.” Although conceptually sensible, implementing CBE has proven challenging. This article will define competence, outline appropriate assessment tools to assess technical skill, and review the literature on the number of cases required to achieve competence in colorectal procedures while outlining the barriers to implementing CBE.

European Society of Coloproctology guideline on training in robotic colorectal surgery (2024)

“…Louridas et al. [69], in a narrative review, summarized available literature on competency‐based education in both minimally invasive and robotic colorectal surgery. The authors focused this review on understanding learning curves, choice of assessment tools, standard setting and potential transferability of competency in laparoscopic surgery to robotic surgery.…”

Transferability of robotic console skills by early robotic surgeons: a multi-platform crossover trial of simulation training

“…Assessing competency and proficiency is rapidly becoming the future of surgical education [ 15 , 16 , 20 ]. Informed by objective measurements of skill and performance capturing the true essence of skills- based performance is within reach in robotics education through simulation training.…”

Preceptorship in robotic colorectal surgery: experience from the Australian private sector

“…When establishing the desired outcome, there must be a common definition of goals. Louridas and de Montbrun who have published extensively on surgical education have outlined the importance of differentiating between competency and proficiency [ 12 ]. Competency denotes the foundational level of skill necessary to execute a task safely and without supervision, whereas proficiency indicates a more advanced skill level, approaching mastery and exceeding mere competency [ 12 , 13 ].…”

“…Louridas and de Montbrun who have published extensively on surgical education have outlined the importance of differentiating between competency and proficiency [ 12 ]. Competency denotes the foundational level of skill necessary to execute a task safely and without supervision, whereas proficiency indicates a more advanced skill level, approaching mastery and exceeding mere competency [ 12 , 13 ]. These concepts were supported in a systematic review by Szasz et al, with technical competence having the common theme of a ‘minimum standard’ versus proficiency indicating a more advanced skillset [ 13 ].…”