Surgical Skill Transference: Independent Development of Complex Technical Skills Across Open, Laparoscopic, and Robotic Platforms in Residency Training

Objective To evaluate whether technical performance in open, laparoscopic, and robotic gastrojejunostomy simulation transfers across operative platforms among general surgery residents completing structured curricula. It was hypothesized that residents would improve within each curriculum, but that final technical performance in one modality would not reliably predict performance in the others. Design Retrospective single-institution cohort study using a prospectively maintained simulation performance database. Final technical performance within each modality was used as the primary outcome. Residents were stratified within each modality as low-, middle-, or high-performing based on final assessment score, and cross-platform performance tier concordance was assessed. Setting Grainger Center for Simulation and Innovation at Endeavor Health Evanston Hospital, Evanston, Illinois. Participants Thirty-two University of Chicago general surgery residents who completed open, laparoscopic, and robotic side-to-side gastrojejunostomy simulation curricula between 2019 and 2025. Results Only 7 residents (21.9%) remained in the same performance tier across all 3 modalities, including 2 residents (6.3%) who were high performers across open, laparoscopic, and robotic simulation. Pairwise categorical tier concordance was not significant between open and laparoscopic performance (p = 0.1980), open and robotic performance (p = 0.3366), or laparoscopic and robotic performance (p = 0.5084). Score-based analyses similarly showed no consistent pattern of cross-platform performance transference. Despite this, residents improved significantly from initial to final assessment in open (19.9 ± 4.9-31.6 ± 1.9), laparoscopic (16.4 ± 3.8-22.6 ± 1.6), and robotic simulation (19.3 ± 2.1-25.8 ± 2.2; all p < 0.0001). Prior operative experience, self-reported skill, comfort, and robotic workload measures were not consistently associated with final performance. Conclusions Structured simulation improved technical performance within each modality, but final performance did not reliably transfer across open, laparoscopic, and robotic platforms. These findings suggest that complex technical skill development remains platform specific and support early, dedicated, and longitudinal simulation-based training across all 3 domains during residency.