OBJECTIVE: This study aimed to investigate the validity of simulation-based assessment of robotic-assisted cardiac surgery skills using a wet lab model, focusing on the use of a time-based score (TBS) and modified Global Evaluative Assessment of Robotic Skills (mGEARS) score. METHODS: We tested 3 wet lab tasks (atrial closure, mitral annular stitches, and internal thoracic artery [ITA] dissection) with both experienced robotic cardiac surgeons and novices from multiple European centers. The tasks were assessed using 2 tools: TBS and mGEARS score. Reliability, internal consistency, and the ability to discriminate between different levels of competence were evaluated. RESULTS: The results demonstrated a high internal consistency for all 3 tasks using mGEARS assessment tool. The mGEARS score and TBS could reliably discriminate between different levels of competence for the atrial closure and mitral stitches tasks but not for the ITA harvesting task. A generalizability study also revealed that it was feasible to assess competency of the atrial closure and mitral stitches tasks using mGEARS but not the ITA dissection task. Pass/fail scores were established for each task using both TBS and mGEARS assessment tools. CONCLUSIONS: The study provides sufficient evidence for using TBS and mGEARS scores in evaluating robotic-assisted cardiac surgery skills in wet lab settings for intracardiac tasks. Combining both assessment tools enhances the evaluation of proficiency in robotic cardiac surgery, paving the way for standardized, evidence-based preclinical training and credentialing. CLINICAL TRIAL REGISTRY NUMBER: NCT05043064.

Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Madrid Spain

Copenhagen Academy for Medical Education and Simulation Rigshospitalet Denmark

Department of Cardiac Surgery Na Homolce Hospital Prague Czech Republic

Department of Cardiac Surgery Ospedale Sant'Andrea Sapienza University of Rome Rome Italy

Department of Cardiothoracic Surgery Aalborg University Hospital Aalborg Denmark

Department of Cardiothoracic Surgery Amsterdam University Medical Center Amsterdam The Netherlands

Department of Cardiothoracic Surgery Leiden University Medical Center Leiden The Netherlands

Department of Cardiovascular Surgery Hospital Clínic Barcelona Spain

Department of Clinical Medicine Aalborg University Aalborg Denmark

Department of Gastrointestinal and Hepatic Diseases Copenhagen University Hospital Herlev and Gentofte Herlev Denmark

Department of Medicine University of Copenhagen Denmark

Department of Obstetrics Copenhagen University Hospital Rigshospitalet Denmark

Division of Cardiac Surgery Department of Surgery Western University London Health Sciences Center London Ontario Canada

Nordsim Aalborg University Hospital Aalborg Denmark

ROCnord Robotic Centre Aalborg Aalborg University Hospital Aalborg Denmark

Unit of Clinical Biostatistics Aalborg University Hospital Aalborg Denmark

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Examining the learning curves in robotic cardiac surgery wet lab simulation training

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NCT05043064