Alexander Beulens

13 Introduction and Outline of the Thesis Basic Proficiency Requirements for Robot assisted surgery In 2010, the Dutch health care inspectorate (Inspectie Gezondheidszorg en Jeugd, IGJ) published a report stating ‘insufficient carefulness at the introduction of surgical robots. In this report, the IGJ expressed their concern over the lack of clearly stated criteria for starting robot–assisted laparoscopy. It is increasingly accepted by the medical community to safeguard a minimal competency level for residents. The majority of robot assisted surgeons in the Netherlands agree that the basics in robotic surgery should be incorporated in a structured training program to guarantee the quality of the surgeon and the safety of the patient.19 The lack of structured training program and defined skills-criteria results in a training programme developed by the novice surgeons based on their perceived lack of knowledge.20,21 This, by the novice developed, training programme could result in a hiatus of knowledge due to overconfidence biases, an over-assessment of skills compared to the objective assessment of skills by an external observer.22 The lack of defined skills-criteria resulted in a study by the Netherlands institute for health services research (NIVEL), commissioned by the Dutch Ministry of Health, Welfare and Sport, in collaboration with a number of experts in which the ‘Basic proficiency requirements for the safe use of robotic surgery’ were investigated.23. The existence of these Basic Proficiency Requirements enables the specific development of training curricula for novice surgeons and the structured evaluation surgical skills in both novice and expert surgeons. The Basic Proficiency Requirements are a first step towards defining surgical skills and in enabling surgical skills assessment for both novice and expert surgeons. The question remains how these Basic Proficiency Requirements can be integrated into existing training programs and competency assessment methods. Surgical Skills in novice surgeons Different methods of training in robot assisted surgery have been researched.24–28 These results have been developed into multiple training curricula, some of which are implemented by the European Association of Urology Robotic Urology Section (ERUS) robotic urology fellowship curriculum, Fundamental Skills of Robotic Surgery (FSRS), Fundamentals of Robotic Surgery (FRS) and the Basic Skills Training Curriculum (BSTC). Although these curricula need thorough validation these are promising steps in the development of standardized robot surgery curricula.29 A well described and often cited modular training pathway for the laparoscopic prostatectomy is described by Stolzenburg et al.(2005).30 This training pathway neverthe-