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Invited Commentary
May 20, 2020

Surgical Training Benefits From the Cumulative Outcomes of Proficiency-Based Training and Mentorship

Author Affiliations
  • 1Division of Surgery and Interventional Science, Research Department of Targeted Intervention, University College London, London, United Kingdom
JAMA Surg. Published online May 20, 2020. doi:10.1001/jamasurg.2020.1041

As the use of robotic surgery for complex procedures increases, there is a growing awareness of the need for validated and standardized curricula that can safely deliver procedural training while limiting errors associated with inexperience. In the article in this issue of JAMA Surgery by Rice et al,1 the authors have reported the learning curves for 3 generations of surgeons performing a robotic pancreatoduodenectomy (a Whipple procedure). The first pioneering generation of surgeons was likely on a combination of learning and discovery curves of how best to use robotics. Once the procedural steps were defined and standardized, the second generation avoided errors and inefficiencies with the aid of mentorship from experienced colleagues. The third generation received training in a proficiency-based progression (PBP) curriculum benchmarked with defined objective metrics. These required demonstration of proficiency before progressing through the curriculum, as well as experienced mentors guiding students and taking over when required. The outcomes of these 2 elements were shown to be cumulative, and this is an important finding and insight.

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