As I come towards the end of my robotic fellowship in Bordeaux and prepare for my transition to consultant life I have found myself thinking about how I can take the skills and lessons I have learnt in robotic colorectal surgery and pass them onto those coming through surgical training behind me. I have seen first hand how an active robotic training programme can be inclusive of all trainees, irrespective of training grade, can help build and promote team ethos and can really invigorate trainees and the wider team. I have loved working alongside my French trainee team, all of whom have been my robotic bedside surgeons at some stage and who I have had the privilege to train in key component parts of robotic colorectal surgery. Replicating this back home in the UK will be challenging, but not impossible, given the growing interest in robotics amongst junior and senior trainees alike. However, I am aware that despite the enthusiasm and interest in robotic surgery the reality for many surgical trainees in the UK is that formal access and training opportunities are limited. The recently published Association of Surgeons in Training (ASiT) survey highlights that less than 12 per cent of trainees are exposed to robotic training, which is likely to reflect issues around access, volume and a lack of experienced trainers. However, as robotic surgery continues to grow and due attention is placed on developing structured and standardised training programmes, the number of trainees being exposed to robotics during surgical training will expand.
My personal feeling is that there is much to learn about robotic surgery, both inside and outside theatre, and that robotic training can be accessible to ALL surgical trainees, irrespective of training grade. I truly believe that maximising all available opportunities centred around robotic surgery will serve you well in the long run by improving your understanding of the principles of robotic surgery, opening doors to new networks and collaborations and ultimately providing you with the opportunity to gain technical skills. Here are just some of the ways ALL trainees can maximise their robotic training opportunities.
Over the last year or so, a number of trainee-led surgical societies have heavily featured robotics in their surgical conferences. The latest ASiT collaboration with Cambridge Medical Robotics (CMR) reflects this growing interest and is a step in the right direction in introducing robotic technology early into surgical training. I am reliably informed that this collaboration will be suitably targeted for novice robotic surgeons, which will be ideal for junior trainees. Similarly, a number of medical student surgical societies have featured robotic lectures across all surgical specialties as part of their annual meetings in recent times. Keep an eye out for these surgical society conferences as they are usually free, attract high quality robotic speakers and provide great soundbites for what robotic surgery has to offer across a multitude of surgical specialities.
Robotic surgery is ripe for research, with a number of emerging groups investigating various aspects of robotics, including training novice surgeons and curriculum development. There is plenty of opportunity to get involved in a variety of robotic projects, from collecting data to participating in simulation and training exercises. The Royal College of Surgeons RADAR (Robotic and Digital Surgery Initiative) Trainees committee, through its Technology Enhanced Surgical Training report, is due to start advertising research projects soon, which are ideally suited for medical students and junior doctors of all levels to get involved in. For those of you who are interested in pursuing a formal period of research, there are a steady trickle of MDs and PhDs being advertised in robotic surgery. The #advancecolorectal team is hoping to release a number of exciting robotic research projects over the next few months so keep your eyes peeled!
There are a multitude of online resources available for budding robotic surgeons, which range from online training resources provided by key industry providers to high quality educational videos on YouTube. The virtual ASiT x CMR Introduction to Surgical Robotics webinar provided the ideal spring board for medical students and junior doctors, and I’m sure there will be much more to come from this collaboration.
Robotic simulation is so important as it helps you get comfortable with the basic principles of robotics, allows you to handle the surgeon cart and builds muscle memory. This is the first key step in your robotic training pathway and its never too early to start! There are lots of exciting developments in simulation and robotic training outside of the theatre complex which are worth looking into including virtual, hands-on and cadaveric courses.
There are some incredible, high volume, enthusiastic robotic surgeons dotted around the country. Seek them out and ask them how you can get involved in robotics or if they are in your region ask whether they would be happy to train you. I certainly did this during my surgical training as a ST7 at Sunderland and for my fellowship in Bordeaux. Just because a robotic surgeon hasn’t previously been a trainer doesn’t mean they can’t be one in the future! And, for those of you training in the North West of England I will be looking to train my surgical trainees using the principles of component based operating.
I would advise you to make the most of all the robotic surgical opportunities that come your way in theatre. Make the most of being in a robotic theatre by understanding the set-up, team dynamic, interplay between bedside and console surgeon. Take the opportunity to be a robotic bedside assistant and use this as an active learning opportunity by observing and understanding how the patient cart and surgeon console work and interact, building on your communication skills and develop specific problem-solving strategies for robotic surgery.
Ultimately, you have to be realistic with regards to your expectations of robotic training within the current climate. I found robotic training to be a real rollercoaster with highs and lows, including lulls in training periods due to a lack of an experienced trainer, however, despite this I was able to forge my own path and I truly believe so can you by having realistic expectations, a little bit of patience and maximising all those additional opportunities. Is robotics for ALL trainees? I think so I just think you have to change your mindset and approach to training in this arena.