Next generation of procedural skills curriculum development: Proficiency-based progression

Background: Until recently training, assessment and certification of technical procedural skills (surgical and other interventional procedures) has been a matter of subjective evaluation by a faculty or senior peer. A few new technical skills courses have begun quantifying surgical performance, however none have required benchmark scores that must be met to guarantee proficiency. Based on nearly 100 years of technical skills simulation in other high-risk sectors (aviation, military, nuclear industry, etc.), a new, comprehensive procedural skills curriculum development process, entitled 'full life-cycle curriculum development' and which uses the principles of proficiency-based progression, has been developed and implemented for the Fundamentals of Robotic Surgery (FRS) curriculum – a simulation course for technical skills with quantitative metrics. Methodology: Four consensus conferences by Delphi method, with official representatives of 14 surgical specialties that use robotic surgery was conducted to develop Outcomes Measures/metrics, Didiactic Curriculum, Simulation Content for a novel simulator, and Validation Trial. Proficiency-based progression, based upon expert performance benchmarks, was used to establish the scores which the novices must complete in order to pass. Results: An initial pilot study for validation of this new curriculum process has been completed to determine rough-order-magnitude of parameters and usability and practicality, as well as a preliminary evaluation of suitability as an educational course. A final full validation study is in progress to confirm the initial results of both the validity and educational value of this course. A validated course for gynecologic robotic surgery has been completed and validated using the same templates as the FRS. Conclusion: The FRS use a new process (full life-cycle curriculum development with proficiency-based progression) which can be used in order to develop any quantitative procedural curriculum, through generic templates that have been developed. Such an approach will dramatically decrease the cost, time and effort to develop a new specific curriculum, while producing uniformity in approach, inter-operability among different curricula and consistency in objective assessment. This process is currently online, open source and freely available, to encourage the adoption of a scholarly and rigorous approach to curriculum development which is flexible enough to be adopted and adapted to most technical skills curriculum needs