Proficiency-based training and credentialing can improve patient outcomes and decrease cost to a hospital system

Vernissia Tam, Jeffrey Borrebach, Stefanie Altieri Dunn, Johanna Bellon, Herbert J. Zeh, Melissa E. Hogg

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Background: While proficiency-based robotic training has been shown to enhance skill acquisition, no studies have shown that training leads to improved outcomes or quality measures. Methods: Board-certified general surgeons participated in an optional proficiency-based robotic training curriculum and outcomes from robotic hernia cases were analyzed. Multivariable analysis was performed for operative times to adjust for patient and surgical variables. Results: Six out of 16 (38%) surgeons completed training and 210 robotic hernia cases were analyzed. Longer operative times were associated with bilateral repairs (observed-to-expected operative time ratio [OTR] = 1.41, p < 0.001) and incarceration (OTR = 1.24, p = 0.006), while female patients (OTR = 0.87, p = 0.001) and increasing chronologic case order (OTR = 0.94, p < 0.001) were associated with shorter operative times. Surgeons who completed robotic training achieved shorter OTRs than those who did not (p = 0.03). Comparing non-risk adjusted hospital costs, trainees had an average of $1207 in savings (20% reduction) per robotic hernia case. Conclusions: A structured proficiency-based robotics training curriculum is an effective way to reduce operative times and costs.

Original languageEnglish (US)
Pages (from-to)591-596
Number of pages6
JournalAmerican journal of surgery
Issue number4
StatePublished - Apr 2019
Externally publishedYes


  • Operative time
  • Proficiency
  • Robotic inguinal hernia
  • Simulation

ASJC Scopus subject areas

  • Surgery


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