50 Chapter 2 Discussion In this study, we aimed to answer the following research questions: (1) Are novice robot surgeons able to accurately estimate their knowledge and dexterity skills after initial training? (2) Is it possible to include the basic proficiency requirements for the safe use of robotic surgery as developed by the NIVEL in a 1 day training? To answer these questions, we analysed the results of a 1-day training programme which included BPR. To answer if novice robot surgeons are able to accurately estimate their theoretical knowledge and dexterity skills the questionnaire results are compared to the results from the MIMIC dv-Simulator simulation exercises. Although the questionnaire results are based on a self-reported competence judgement by the participants, and not the result of a test or simulation exercise, it illustrates participants feel competent to deal with the provided situations at the end of training. However, this feeling might not be completely justified as the results of the MIMIC dv-Simulator simulation exercises were performed proficiently by 0%, 44% and 58% of the participants. Participants were kept unaware of their skill simulation scores and the corresponding reference scores. Since all participants responded they, in their opinion, mastered the requirements corresponding to these simulation exercises this could be a case of over-assessment of their own skill compared to the objective assessment of this skill (overconfidence biases). This phenomenon has been described in multiple studies.6,12 Since the questionnaire about the basic proficiency requirements was not filled out until after the training, and no pre-training-measurement was performed it is difficult to say if this self-reported mastery of the basic proficiency requirements can only be attributed to over-assessment of the participants in their skill alone or if the participants mastery of the simulation exercises is not a valid measurement for the mastery of the basic proficiency requirements developed by the NIVEL. Although face validity of the questionnaire was investigated using a panel of expert in the field of robotic surgery further validation of the questionnaire was not possible since no similar questionnaires exist and the response was too small to perform statistical validation of the questionnaire. Participant’s theoretical knowledge was not tested during the training. We assume the results of their self-reported evaluation are influenced by the same principle of overconfidence bias. To investigate if this is the case testing of theoretical knowledge has to be integrated in a further implementation of the training. To answer if it is possible to include the basic proficiency requirements for the safe use of robotic surgery as developed by the NIVEL in one training the results of the
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