330 Chapter 13 Skills (E-BLUS) examination,1–3 but, no such guidelines exist for RAS. Since no set criteria or guidelines exist, most novice robot surgeons are left to their own devices when first learning robot assisted surgery. In this thesis we investigated to what extent novice robot surgeons were able to self-assess their own knowledge and dexterity skills. The results showed novice robot surgeons are overconfident in the self-assessment of their own dexterity skills after a 1-day training in robot assisted surgery (with the danger of self-assessment bias). This shows novice robot surgeons should be informed about their competence levels after surgical skills training in order to reduce the chances of self-assessment bias. There are different forms of feedback to inform novice surgeons of their competence levels during surgery. Examples are simulator generated guidance (instructions and guidance by the virtual reality (VR) simulator) and human proctoring (instruction by an expert surgeon). The effect of these methods of feedback on dexterity skills acquisition and participants satisfaction during surgical skills training in novice robot surgeons was investigated in this thesis. The results show that novice surgeons can significantly increase their dexterity skills in RAS after 2 hours of practicing on a VR simulator. The impact of “human proctoring” seems to be limited compared to “VR simulator generated guidance” on the acquisition of dexterity skills during the initial phase of surgical simulation training since there is no significant difference between the groups. The participant satisfaction was slightly higher in the “human proctoring” group. The exposure of novice surgeons to the robotic surgery simulator alone could possibly be sufficient to significantly improve dexterity skills during the initial steps of RAS learning. Since, no set criteria or guidelines exist in the Netherlands for starting RAS, it is paramount to gain insight into the current state of RAS training during the urology residency. The results of this thesis show that criteria for starting RAS differ significantly among teaching hospitals. Questionnaires among all Dutch urology residents show a large portion of residents are allowed to participate in RAS during their residency, after completing a variable set of criteria. In order to provide a standardised training for urology residents an advanced course in RAS was organised. The results of the residents who were selected for this course showed a significant improvement in their surgical skills during the course. The implementation of a (multi-step) training and certification program in the Dutch residency curriculum in urology should be considered. It should be the obligation of teachers/supervisors to ensure a novice surgeon is trained and certified in the skills of RAS4 before they perform their first surgery on a patient. Although there has been little research into the effects of surgeon training on the postoperative outcome of patients5,6 structured training should be implemented to ensure a basic skills level for all novice surgeons in order to reduce the risks on complications for the
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