Give and Take of Operative Autonomy: Entrustment Process of Console Control Between Trainers and Trainees in Robotic-Assisted Surgery Training.

OBJECTIVE: In robotic-assisted surgery (RAS) training, console mediated control of the instruments and operative field, spatial configuration, and different systems change the training dynamics between trainers and trainees. Consequently, RAS changes the entrustment process or how operative autonomy is given and taken in surgical training. This study aims to examine entrustment in RAS training within a national training framework across multiple institutions, specialties, and factors within and beyond intraoperative interactions. DESIGN: We conducted semi-structured interviews and analyzed the data using reflexive thematic analysis. SETTING: Participants included 12 trainers practicing at five teaching hospitals and 8 trainees rotating their training through different hospitals every six months or a year. PARTICIPANTS: Participants included 20 surgeons affiliated with the Royal College of Surgeons in Ireland. They were asked how trainers made decisions in giving trainees console control and taking it back. They were also asked how trainees were trained as the primary operating surgeon at the console. RESULTS: Diverse prerequisites were reported that must be met before trainee was deemed ready to be given the console time. Then, trainer and trainee set learning goals. Trainee also showed certain behaviors such as case preparation to be entrusted. Intraoperatively, trainer was reported to use various teaching strategies including step-based and time-based approaches to gradually entrust trainee certain parts of the procedure, while using cues such as lack of progress and time to decide console takeover. At the end, trainer and trainee debriefed and planned for future entrustment. Gender was also reported to play a role in the entrustment process. CONCLUSIONS: We provide a roadmap of the entrustment process that trainers and trainees use to give and take the operative autonomy till trainees become independent in RAS training. We also provide concrete teaching and learning strategies that they can use as guidance in their practice.