Entrustment of General Surgery Residents in Robotic Surgery and Utility of a Robotic Portfolio to Promote Prospective Entrustment

Purpose Operative entrustment decisions are shaped by individual and contextual factors. Despite the growth of robotic surgery, resident autonomy is often limited with this platform. This study explored how faculty surgeons approach entrustment decisions in robotic surgery, and the perceived impact of a resident robotic portfolio. Methods We conducted semi-structured interviews of robotic surgical faculty at two academic centers that work with general surgery residents. Purposive sampling identified faculty with varied specialties and years of experience. We developed a sample resident portfolio including case numbers, simulation experience, and description of percentage console time and parts performed of a representative case. Interviews were transcribed verbatim and deidentified. Coding and thematic analysis were conducted iteratively in an inductive fashion. Results Participants included 13 faculty surgeons with most common robotic case types of hernia (n = 8), colorectal (n = 3) and bariatrics (n = 2). Primary themes identified were entrustment “pre-test probability,” validation of initial entrustment, and ways the robotic platform promotes and challenges entrustment. The resident portfolio is informative and increases the faculty’s pre-test probability of prospective entrustment. Despite objective data of the portfolio, faculty still need to validate the trainee’s robotic skill level through direct observation. Faculty promote entrustment by utilizing dual console and telestration, but residents must adapt to the robotic console and learn visual haptics. Conclusion Our findings highlight factors that influence a “pre-test probability” of prospective entrustment in robotic surgery. While a resident portfolio could promote competency-based entrustment, faculty need to validate the robotic skillset and utilize teaching strategies tailored to the robotic platform.