CC BY-NC-ND 4.0 · Zentralbl Chir
DOI: 10.1055/a-2386-9463
Originalarbeit

Modified Delphi Procedure to Achieve Consensus for the Concept of a National Curriculum for Minimally Invasive and Robot-assisted Surgery in Germany (GeRMIQ)

Artikel in mehreren Sprachen: deutsch | English
Tobias Huber
1   Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland (Ringgold ID: RIN39068)
,
Julia Weber
2   Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
,
Felix von Bechtolsheim
3   Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus,  Technische Universität Dresden, Dresden, Deutschland
,
Sven Flemming
4   Klinik und Poliklinik für Allgemein-, Viszeral-, Transplantations-, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Deutschland (Ringgold ID: RIN27207)
,
Hans Friedrich Fuchs
5   Klinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinikum Köln, Köln, Deutschland
,
Marian Grade
6   Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
,
Richard Hummel
7   Klinik für Allgemeine Chirurgie, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsmedizin Greifswald, Greifswald, Deutschland (Ringgold ID: RIN60634)
,
Christian Krautz
8   Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Erlangen, Erlangen, Deutschland
,
Jessica Stockheim
9   Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland (Ringgold ID: RIN39067)
,
Michael Thomaschewski
10   Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Kiel, Deutschland (Ringgold ID: RIN54186)
,
Dirk Wilhelm
11   Klinik und Poliklinik für Chirurgie, Technische Universität München, School of Medicine and Health, München, Deutschland (Ringgold ID: RIN9184)
,
Jörg C. Kalff
2   Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
,
Felix Nickel
12   Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland (Ringgold ID: RIN37734)
,
Hanno Matthaei
2   Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
› Institutsangaben

Abstract

Background

The rapid development of minimally invasive surgery (MIS) and robot-assisted surgery (RAS) requires standardized training to ensure high-quality patient care. In Germany, there is currently a lack of a standardized curriculum that teaches these specialized skills. The aim of this study is to find a consensus for the development of a nationwide curriculum for MIS and RAS with the subsequent implementation of the consented content.

Methods

A modified Delphi process was used to reach consensus among national experts in MIS and RAS. The process included a literature review, an online survey and an expert conference.

Results

All 12 invited experts participated in the survey. They primarily achieved consensus on 73% and secondarily within the expert conference on 95 out of 122 questions (77.9%). The preference for a basic curriculum as a foundation on which specialized modules can build on was particularly clear. The results support the development of an integrated curriculum for MIS and RAS that includes step-by-step training from theoretical knowledge via e-learning modules to practical skills in dry lab simulations and in the OR. Emphasis was placed on the need to promote clinical judgment and decision making through targeted assessment during the learning curve to ensure effective application of learned skills in clinical practice. There was also a consensus that training content must be aligned with learners’ skill acquisition using objective performance assessments in line with the principle of proficiency-based progression (PBP). The continuous updating of the curriculum to keep it up to date with the latest technology was considered essential.

Conclusion

The study underlines the urgent need for a standardized training curriculum for MIS and RAS in Germany in order to increase patient safety and improve the quality of surgical care. There is broad expert consensus for the implementation of such a curriculum. It aims to ensure a contemporary and internationally competitive uniform quality of training and to increase the attractiveness of surgical training.



Publikationsverlauf

Eingereicht: 05. April 2024

Angenommen: 11. Juni 2024

Artikel online veröffentlicht:
12. Dezember 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 
  • Literatur

  • 1 George EI, Brand TC, LaPorta A. et al. Origins of Robotic Surgery: From Skepticism to Standard of Care. JSLS 2018; 22: e2018.00039
  • 2 Feng Q, Yuan W, Li T. et al. Robotic versus laparoscopic surgery for middle and low rectal cancer (REAL): short-term outcomes of a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol 2022; 7: 991-1004
  • 3 Brunner S, Müller DT, Eckhoff JA. et al. Innovative Operationsroboter und Operationstechnik für den Einsatz am oberen Gastrointestinaltrakt. Onkologie 2023;
  • 4 Chadebecq F, Lovat LB, Stoyanov D. Artificial intelligence and automation in endoscopy and surgery. Nat Rev Gastroenterol Hepatol 2023; 20: 171-182
  • 5 Feodorovici P, Arensmeyer J, Schnorr P. et al. Einsatz von erweiterten Realitäten (XR) in der Thoraxchirurgie. Zentralbl Chir 2023; 148: 367-375
  • 6 Khan MTA, Patnaik R, Lee CS. et al. Systematic review of academic robotic surgery curricula. J Robot Surg 2023; 17: 719-743
  • 7 Stockheim J, Perrakis A, Sabel BA. et al. RoCS: Robotic Curriculum for young Surgeons. J Robot Surg 2023; 17: 495-507
  • 8 Thomaschewski M, Kist M, Zimmermann M. et al. Conception and prospective multicentric validation of a Robotic Surgery Training Curriculum (RoSTraC) for surgical residents: from simulation via laboratory training to integration into the operation room. J Robot Surg 2024; 18: 53
  • 9 Huber T, Huettl F, Vradelis L. et al. [Evidence, Availability and Future Visions in Simulation in General and Visceral Surgery]. Zentralbl Chir 2023; 148: 337-346
  • 10 Huber T, Hüttl F, Braun B. et al. [Fridays for future! – All days for surgery!: Thoughts of young surgeons on a modern promotion of the next generation]. Chirurg 2022; 93: 250-255
  • 11 Datta RR, Bohle J, Schmidt T. et al. Der „Surgical Track “– innovative Ansätze gegen den Nachwuchsmangel in der Chirurgie. Chirurgie (Heidelb) 2024; 95: 315-323
  • 12 Bennett C, Vakil N, Bergman J. et al. Consensus statements for management of Barrett’s dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process. Gastroenterology 2012; 143: 336-346
  • 13 Levy JS, Gharagozloo F. Development of the fundamentals of thoracic robotic surgery curriculum. J Thorac Dis 2021; 13: 6116
  • 14 Peters JH, Fried GM, Swanstrom LL. et al. Development and validation of a comprehensive program of education and assessment of the basic fundamentals of laparoscopic surgery. Surgery 2004; 135: 21-27
  • 15 Hiemstra E, Kolkman W, Jansen FW. Skills training in minimally invasive surgery in Dutch obstetrics and gynecology residency curriculum. Gynecol Surg 2008; 5: 321-325
  • 16 Krüger C, Rückbeil O, Sebestyen U. et al. DeRAS I – deutsche Situation der robotisch assistierten Chirurgie – eine Online-Survey-Studie. Chirurg 2021; 92: 1107-1113
  • 17 Cameron JL. William Stewart Halsted. Our surgical heritage. Ann Surg 1997; 225: 445-458
  • 18 Kotsis SV, Chung KC. Application of see one, do one, teach one concept in surgical training. Plast Reconstr Surg 2013; 131: 1194
  • 19 Lawrie L, Gillies K, Davies L. et al. Current issues and future considerations for the wider implementation of robotic-assisted surgery: a qualitative study. BMJ Open 2022; 12: e067427
  • 20 Ghadban T, Reeh M, Bockhorn M. et al. Minimally invasive surgery for colorectal cancer remains underutilized in Germany despite its nationwide application over the last decade. Sci Rep 2018; 8: 15146
  • 21 National Bowel Cancer Audit (NBOCA). Annual Report 2019. January 2020. Zugriff am 15. August 2024 unter: https://www.nboca.org.uk/reports/annual-report-2019/
  • 22 Schardey J, Huber T, Kappenberger AS. et al. [Expected effects of the new continuing education regulations in general and visceral surgery: Survey among Bavarian surgeons and residents]. Chirurgie (Heidelb) 2023; 94: 155-163
  • 23 Schardey J, Hüttl F, Jacobsen A. et al. Die Neue Weiterbildungsordnung – eine Herausforderung für die Viszeralchirurgie. Ergebnisse einer Umfrage unter DGAV-Mitgliedern und Lösungsstrategien der Jungen Chirurgie. Chirurgie (Heidelb) 2024; 95: 563-577
  • 24 Lee JY, Mucksavage P, Sundaram CP. et al. Best practices for robotic surgery training and credentialing. J Urol 2011; 185: 1191-1197
  • 25 Sroka G, Feldman LS, Vassiliou MC. et al. Fundamentals of laparoscopic surgery simulator training to proficiency improves laparoscopic performance in the operating room—a randomized controlled trial. Am J Surg 2010; 199: 115-120
  • 26 Ruiz JG, Mintzer MJ, Leipzig RM. The impact of E-learning in medical education. Acad Med 2006; 81: 207-212
  • 27 Mori T, Hatano N, Maruyama S. et al. Significance of “hands-on training” in laparoscopic surgery. Surg Endosc 1998; 12: 256-260
  • 28 Feldman LS, Pryor AD, Gardner AK. et al. SAGES Video-Based Assessment (VBA) program: a vision for life-long learning for surgeons. Surg Endosc 2020; 34: 3285-3288