Simulation-based training in robot-assisted laparoscopic surgery (RALS): a randomized comparison of co-regulated and instructor-regulated dyad training

Abstract Introduction Over the last decade, robot-assisted laparoscopic surgery (RALS) has significantly influenced the field of surgery. It is important to develop an efficient, evidence-based curriculum without jeopardizing patient safety. Growing evidence suggests that dyad practice may be beneficial in learning procedural skills in surgery. The present study aims to investigate how dyad training influences future learning within RALS. Methods The study was conducted as a rater-blinded randomized controlled trial. A total of 20 participants without independent RALS experience were recruited among surgical residents. Participants were randomized into either conducting virtual reality training as co-regulated learning (CRL) or instructor-regulated learning (IRL) followed by RALS training on a porcine model. Module A test, Module B pre-, and post-test were video recorded for each participant. Two raters assessed performance using The Global Evaluative Assessment of Robotic Skills (GEARS). Statistical comparisons were made using t-tests to assess differences between groups across time periods. Results The CRL group performed significantly worse than the IRL group in Module B pre-test (mean = − 3.3, CI95: − 5.8; − 0.8). In post-test, the CRL and IRL groups obtained no significant difference in performance levels (mean = 0.4, CI95: − 3.0; 3.9). A difference in difference comparison of the groups (CRL vs. IRL) over time (pre-test vs. post-test) showed that the CRL group had a greater improvement in mean scores, with an increase of 3.8 points (95% CI: − 0.2; 7.8). Conclusion This study shows that co-regulated learning in the form of dyads is an efficient way to conduct simulation-based VR training in RALS, however an instructor is needed when training on porcine models.