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Integrating Robotic Technology Into Resident Training: Challenges and Recommendations From the Front Lines

Green, Courtney A. MEd, MD; Mahuron, Kelly M. MD; Harris, Hobart W. MPH, MD; O’Sullivan, Patricia S. EdD

doi: 10.1097/ACM.0000000000002751
Research Reports

Purpose To develop recommendations for improving the integration of robotic technology into today’s apprentice-based resident training.

Method During a national meeting in 2017, 24 robotic surgeons were interviewed about their experiences integrating robotic technology into resident training. Qualitative thematic analysis of interview notes and recordings revealed themes related to challenges and recommendations.

Results Four themes emerged, each corresponding to a general recommendation for integrating robotic technology into training. The first, surgical techniques versus tools, contrasts faculty’s sequential mastery—surgical techniques first, then the robotic tool—with residents’ simultaneous learning. The recommendation is to create separate learning opportunities for focused skill acquisition. The second theme, timing of exposure to the robotic tool, describes trainees’ initial focus on tool use for basic surgical steps. The recommendation is to increase access to basic robotic cases. The third theme covers the relationship of laparoscopic and robotic surgery. The recommendation is to emphasize similar and dissimilar features during all minimally invasive surgical cases. The fourth theme, use of the dual console (which enables two consoles to operate the robot, the primary determines the secondary’s functionality), highlights the unique teaching opportunities this console creates. The recommendation is for surgeons to give verbal guidance so residents completely understand surgical techniques.

Conclusions Surgical educators should consider technique versus tool, timing of exposure to the tool, overlapping and varying features of robotic and laparoscopic surgery, and use of the dual console as they develop curricula to ensure thorough acquisition and synthesis of all elements of robotic surgery.

C.A. Green is a general surgery resident, University of California, San Francisco, San Francisco, California.

K.M. Mahuron is a general surgery resident, University of California, San Francisco, San Francisco, California.

H.W. Harris is professor and chief, Division of General Surgery, J. Engelbert Dunphy Endowed Chair in Surgery, and program director, National Institutes of Health T32 Training Program in Gastrointestinal Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California.

P.S. O’Sullivan is professor, Departments of Medicine and Surgery, and director of research and development in medical education, Center for Faculty Educators, University of California, San Francisco School of Medicine. She is also endowed chair of surgical education, Department of Surgery, University of California, San Francisco, San Francisco, California.

Funding/Support: This work was partially supported by training grant T32 DK007573 in gastrointestinal surgery from the National Institutes of Health.

Other disclosures: None reported.

Ethical approval: This study was approved as exempt by the University of California, San Francisco Human Research Protection Program IRB, May 8, 2017, #17-22060, reference #190554.

Previous presentations: This work was presented on September 6, 2017, during Minimally Invasive Surgery Week hosted by the Society of Laparoendoscopic Surgeons in San Francisco, California.

Data: Some of the quotations in Table 2 were elicited in response to a prompt posted on a monitored social media site. All data were anonymized.

Supplemental digital content for this article is available at

Correspondence should be addressed to Courtney A. Green, University of California, San Francisco, Department of Surgery, 513 Parnassus Ave., S-321, San Francisco, CA 94143-0470; telephone: (651) 329-3976; email:

Copyright © 2019 by the Association of American Medical Colleges