PD19-08 PROFICIENCY-BASED ROBOTIC TRAINING CURRICULUM YIELDS IMPROVEMENTS IN ROBOTIC CLINICAL PERFORMANCE: A RANDOMIZED CONTROLLED STUDY

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reviewers for all clips, with the lowest performance receiving a “pass” score of 73%. CONCLUSIONS: Video-based peer-review of RARP is feasible within a quality improvement collaborative. While reviewers varied in their assessment of technical skill, better agreement was achieved when using the RACE tool. Our study identifies the need for an improved assessment tool for RARP, and the role for pre-assessment training of reviewers to optimize rater agreement.

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CONCLUSIONS: We demonstrated face, content, and construct validity for a novel, low cost and high fidelity robotic intracorporeal bowel anastomosis model. Our results indicate that the BARS simulation may provide a valuable training modality to practice surgical skills required for this operation. Source of Funding: none

PD19-08 PROFICIENCY-BASED ROBOTIC TRAINING CURRICULUM YIELDS IMPROVEMENTS IN ROBOTIC CLINICAL PERFORMANCE: A RANDOMIZED CONTROLLED STUDY Monty Aghazadeh, Miguel Mercado, Michael Pan, Neel Srikishen*, Brian Miles, Richard Link, Brian Dunkin, Alvin Goh, Houston, TX

Source of Funding: Blue Cross Blue Shield of Michigan

PD19-07 VALIDATION OF A TRAINING MODEL FOR INTRACORPOREAL BOWEL ANASTOMOSIS IN ROBOTIC SURGERY (BARS) Friedrich-Carl von Rundstedt*, Selcuk Silay, Monty Aghazadeh, Alvin Goh, Houston, TX INTRODUCTION AND OBJECTIVES: Increased utility of robotic radical cystectomy and performance of an intracorporeal bowel anastomosis require realistic simulation for efficient training and objective skills assessment. We have developed a model using an abdominal trainer and porcine bowel to practice basics steps for the intracorporeal bowel anastomosis in robotic surgery. METHODS: A total of 17 urological surgeons including urology residents, fellows and attendings were enrolled in the study. All participants were instructed with a video of the BARS model prior to performing the exercise. The BARS model includes four consecutive excercises such as the (1) division of the bowel, (2) incision of the antimesenterial angle, (3) side-to side anastomosis and (4) transverse closure of the anastomosis with a laparoscopic stapler. BARS scores were based on accuracy and efficiency. Global Evaluative Assessment of Robotic Skills (GEARS) scores and exercise specific performance scores were recorded for a comprehensive assessment of all participants. All participants were asked to complete a survey to assess for face and content validity. Statistical analysis included comparison of all variables between the experts and the trainees. RESULTS: Ten trainees and seven experts in robotic surgery were assessed. Surgeons in the expert group had performed at least 30 robotic procedures (50-7500) as primary surgeons and had a mean age of 45 years. The median number of robotic cases as a primary surgeon in the trainee group was four (0-20) with a mean age of 36 years. The median time (range) for completion of all exercises was 339 (298-708) and 371 (264-1723) for experts and trainees respectively (p¼0.26). The median exercise performance scores were 7 in both groups (p¼0.42). Gears scores were significantly different with 23 and 18 points comparing experts and trainees (p¼0.003). Face Validity: Of all participants, 58% agreed that the tasks were at an appropriate level of difficulty and 67% agreed that the necessary technical skills reflect robotic surgery skills. Content Validity: Of expert participants, 83% agreed that the tasks were useful for skills evaluation; 91% agreed that the tasks were useful for training and that a skilled robotic surgeon should be able to perform all the tasks presented.

INTRODUCTION AND OBJECTIVES: The lack of data regarding the impact of training on robotic clinical performance has precluded the adoption of a standardized robotic training curriculum. Our group has previously established and validated task-specific proficiency levels for 5 inanimate skills (IS) and 8 da Vinci Skills Simulator Virtual Reality (VR) exercises. Herein, we evaluate the impact of a standardized proficiency-based training curriculum employing these specific IS and VR tasks on clinical performance. METHODS: Twenty urology residents from post-graduate years (PGY) 2-6 were enrolled in the curriculum extending between March 2013 and June 2014. All participants underwent a baseline skills assessment consisting of simulation performance as well as performing the endopelvic dissection of robotic prostatectomy (scored by the Global Evaluative Assessment Robotics Skills [GEARS] assessment tool). Residents were then randomized within their PGY and assigned to either: 1) Training Group (TG), train until proficient on 2 consecutive repetitions for each task, or 2) Standard Access Group (SAG), access to training tools, but no defined curriculum. Skills assessment was repeated at the midpoint and at the end of the curriculum for all participants. Median performance scores were compared between groups using the Wilcoxon Rank-Sum test and changes over time within groups were evaluated using the Paired-Sample Wilcoxon test. RESULTS: Seventeen residents completed the required skills assessments, 9 of whom were in the TG. At baseline, no significant differences were noted between TG and SAG on all portions of skills assessments. By the end of the study, both groups saw improvements in performance, but in comparing final scores, the TG significantly outperformed SAG on IS and VR. Clinical performance was also higher in TG, although this was not statistically significant. However, when comparing baseline and final GEARS scores within groups, the improvement over time was significantly different in the TG (p¼0.015), but not in the SAG (p¼0.091). CONCLUSIONS: To our knowledge, this is the first study to evaluate the impact of simulation training on robotic clinical performance over time. We show that a structured proficiency-based robotic curriculum can yield improvements in robotic clinical performance.

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Table 1 Summary statistics comparing first and second year* Year One

Year Two

Total

Unique users

189

184

373

Mean no. of participants

39

46

44

7(3)

10(4)

9(4)

Mean no. of countries (continents) represented Mean no. of new participants

14

15

15

Mean no. of tweet

195

209

202

Mean no. of impressions

130832

242557

184265

Author participation (%)

7/12 (58)

9/12 (75)

16/24 (67)

Original tweets related to topic (%)

62

58

60

Origial tweets related to #urojc (%)

10

5

8

Irrelevant tweets (%)

6

7

6

Re-tweets (%)

22

30

26

* All figures are per month

Source of Funding: None

PD19-10 Source of Funding: None

PD19-09 INTERNATIONAL UROLOGY JOURNAL CLUB ON TWITTER- A GROWING EDUCATIONAL FORUM Isaac Thangasamy*, Brisbane, Australia; Michael Leveridge, Kingston, Canada; Benjamin Davies, Pittsburgh, PA; Brian Stork, Muskegon, MI; Stacy Loeb, New York, NY; Henry Woo, Sydney, Australia INTRODUCTION AND OBJECTIVES: In 2012, we pioneered the first ever international twitter-based journal club (#urojc) to discuss urology articles on a monthly basis with diverse global participation. Since that time, this model of an international twitter-based journal club has been adopted by several other medical specialties including general surgery, respiratory medicine and nephrology. The objective of this study is to examine the development of the urology journal club into an innovative and thriving forum for exchange of ideas, information and opinions since its conception two years ago. METHODS: Monthly twitter analyses such as number of users, tweets and impressions for the journal club were obtained via a thirdparty service called Symplur using the hashtag #urojc. Qualitative analysis was also performed of each individual tweet to assess for relevance to the discussion. Comparisons were made between data from the first and second year of operation of the journal club, including the number and geographic location of participants, as well as the quantity and quality of tweets. RESULTS: See Table 1 for summary statistics. The total number of unique users of #urojc almost doubled from year one to year two. The mean number of total participants increased by seven per month, and mean number of total countries represented increased by three per month. While the number of tweets per month also increased from year one to year two, the proportion of content-relevant tweets remained stably high at approximately 60%. Meanwhile, there was a greater degree of participation from authors of the study being discussed over time. CONCLUSIONS: It is clear that the International Urology Journal Club continues to draw robust participation from a global audience, and serves as a benchmark for twitter-based journal clubs in other specialties. The majority of tweets are relevant to the content of the article, providing a novel forum to discuss new research findings with a global audience.

IMPLEMENTATION OF A WEB-BASED, PROCEDURE-SPECIFIC, ROBOTIC TRAINING EXPERIENCE LOG WITH FEEDBACK AND LONGITUDINAL REPORTING FEATURES Ryan Thorwarth*, Maywood, IL; Marcus Quek, Mawyood, IL; Gopal Gupta, Maywood, IL INTRODUCTION AND OBJECTIVES: The ability to distinguish areas of weakness, receive feedback, and track progress is vital to resident education. It has been shown that residents do not agree with supervising physicians about the frequency and specificity of feedback. Currently, residents are inaccurately logging cases for ACGME as “primary surgeon”, there is no mandated logging of cases at the stepspecific level of the procedure, and no integration of feedback. These conditions suggest that the current mechanism of tracking true operative experience and surgical skill progression is inadequate. It was our objective to establish such a tool for surgical training. METHODS: We propose a tool to log surgical skill progression, experience, and feedback with four major features: 1) A log of robotic case involvement, with nine common procedures deconstructed to their major steps, and a record of program-specific information 2) A built-in function where the resident may request the supervising attending quantitatively review their performance on four surgical skills, and add short notes 3) A function by which a sample video of the case can be reviewed in a blind fashion 4) Have this be accessible on any device, and be of minimal time burden. RESULTS: The web-based app was successfully developed and piloted for 2 months with 6 residents and 5 attendings. A total of 81 cases were logged. A reporting structure was developed where individual residents or administrators could view statistics on several data points including, but not limited to: -

Frequency of each procedure done Resident involvement, step-for-step, for each procedure Statistics broken down by supervising attending A summary of scores for the four surgical skills reviewed

There was a small time burden on residents (84.2 sec þ/- 64.3 per case) and supervisors (122 þ/- 100 sec per case requested for review). Insightful, granular, data on resident experience, skill progression, and learning environment was obtained. For instance, 91% of the 33 robotic prostatectomies logged were logged as primary surgeon, yet bladder neck dissection, dropping of the rectum, and transection of the urethra had <25% involvement. CONCLUSIONS: In hopes of advancing the granularity and ease with which residents/surgeons track their training, we developed a modern, accessible logging system that is ready for multifaceted use at other institutions. We believe this system will enhance the