Communicating from a distance: medical student perspectives from a robotic bedside assist simulation

Abstract

Abstract Background To safely engage medical students in robotic operations as bedside assists would require new curricula. We aimed to understand student perspectives on communication with a console surgeon during a bedside assist simulation as a step in the process of designing an effective bedside assist curriculum. Methods Senior medical students were offered an introductory robotic surgery course. An Intuitive Surgical trainer reviewed robotic features, functionalities, and roles. Then, students participated in a simulation where they introduced an instrument through a laparoscopic port and advanced it into the field of view navigating around obstacles. A non-surgeon researcher conducted post-course focus groups (FGs) to explore participants’ perceptions about communication with the console surgeon during the simulation. Using FG transcriptions, two researchers conducted an inductive thematic analysis. Results Thirteen students (46% female) participated in three FGs. The first theme, tension between hierarchy and patient safety, reflected students’ pressure to follow instructions quickly and obediently from their superior and trepidation about revealing knowledge gaps as barriers to communication. Students also recognized that patient safety as at risk with rote following of instructions in the face of their uncertainty. The second theme identified opportunities to enhance communication including shared vocabulary, effective team dynamics, and explicit expectations. Conclusion Barriers to effective communication between students and surgical faculty exist. Establishing a bedside assist curriculum that teaches relevant terminology, communicating specific expectations, and promoting a team culture that fosters open communication without judgment may safely expand the role for students in robotic cases.