Medical Student Research Fellowship for Summer 2012
Mentor: Baran Sumer, M.D.
Department: Otolaryngology – Head and Neck Surgery
Room number: G7.226
Mail Code: 9035
Phone number: 214-648-2904
Project title: Transoral robotic surgery (TORS): simulation-based standardized training during residency
Human subjects IRB approved project number (where applicable): n/a
Animal subjects IRB approved project number (where applicable): n/a
Project Type (patient-based research, animal-based research, or basic research; this characterization is only to permit a general classification for grouping similar types of projects)
Brief Description of Project:
With an increasing incidence of oropharyngeal squamous cell carcinoma (OPSCC), there is a correspondent need for otolaryngologists to be trained in the most up-to-date and effective means of treatment. While non-surgical therapy has been the mainstay of therapy for many OPSCC's, advances in surgical techniques such as transoral laser microsurgery (TLMS) and TORS have allowed minimally invasive, transoral approaches to the resection of OPSCC that maximize functional and oncologic outcomes. Transoral robotic surgery (TORS) is a minimally invasive technique introduced in 2005 that has good functional and oncologic outcomes when used to treat OPSCC. One advantage of TORS is that in contrast to TLMS surgical standardization can be improved by anatomic resections rather than the tumor based resections often used during TLMS. In an anatomic resection the surgeon removes defined anatomic structures making the surgery easier to define and teach compared to the individualized tumor based surgery demanded by TLMS.
One issue that needs to be resolved to allow wide dissemination of the TORS technique is properly training residents to perform successful TORS resections using robotic platforms such as the Da Vinci surgical system. Part of that training involves using virtual reality simulation with the Da Vinci system to develop, measure, and maintain the skills of resident surgeons. We would like to quantify the effectiveness of the simulation model in preparing physicians to perform TORS, in the context of a standardized protocol incorporating other skill sets required for TORS such as preoperative assessment and endoscopy skills. Our hypothesis is that simulator training over multiple sessions can allow physicians in training to become proficient in the robotic skills necessary for TORS. Furthermore we hypothesize that these skills will undergo a predictable rate of decay when not actively training with the simulator.
To test these hypotheses we will perform the following specific aims:
Aim 1: Set the level of competency on the the da Vinci Surgeon Console and Mimic Virtual Reality simulation program and assess feasibility of recruitment. To achieve this we will test a pilot group of medical students (2-3 students) and assess whether after introductory training and training on the simulator, they can achieve a score of 90% determined by the simulation program's metrics for the selected exercises. If this is not achievable we will reassess what we define as achievable competency based on the group’s average score versus training time.
Aim 2: Define the minimum number of hours needed to become competent. Gather data on a larger group of n = 10-12 medical students who will perform simulation training until competency defined by Aim 1 is achieved.
Aim 3: Measure the rate of skills decay for the trained set of medical students to assess the need for refresher training on the simulator and/or the case volume a surgeon would require to stay competent. To achieve this we will Re-test the same group trained in Aim 2 after breaks from simulation training for preset intervals of time. If decay in competency over time is observed, we will gather data on how many additional hours of simulation training is needed to re-achieve and maintain competency.
Over the summer, the student investigator will collect data on UTSW otolaryngology residents’ or medical students’ performances on TORS simulation to assess the learning curve for achieving competency in TORS. From this study, we will be the first to quantify how much training is necessary to achieve competency in TORS, and additionally, will discover and quantify the rate of decay in TORS competency. This information can be useful in establishing a formal TORS curriculum for residency training, and more universally it can be used to determine how often re-training is needed by practicing surgeons to maintain competency in their surgical skills.
The student researcher will have the opportunity to learn about TORS, head and neck cancer surgery, trial design and hypothesis testing, scientific writing and their research contribution will help develop a potential curriculum and training protocol.
Previous Research Activities or Publications with Medical Students: