Children’s of Alabama residents practice using the urology team’s surgical robot by playing games like Hasbro’s Perfection.
When the Children’s of Alabama urology department acquired its first Da Vinci surgical robot in January 2023, Carmen Tong, D.O., pediatric urologist at Children’s of Alabama, developed a training curriculum that brings in classic children’s games to help residents develop their skills with the new technology.
“There’s a movement in urology to ‘gamify’ the robot,” Tong said. “Such training is vital to the safety of our patients.”
Surgeons are very competitive, she said. “Gamification taps into our competitive side and allows us to push and encourage each other to improve. It helps with camaraderie.”
Indeed, studies show that gamification, whether with actual games like Tong is using or embedding competitions and rewards into skill development, enhances resident engagement.[i]
The curriculum is not, however, all fun and games. Residents and any interested ancillary medical staff learn the robot from the inside out. “The surgeon who’s using that technology should be the most knowledgeable person of that technology,” Tong said. “We have to be prepared to troubleshoot to figure out what’s happening if the components of the robot are not responding the way we want.”
The residents complete online modules and practice surgeries via a video game-type simulator. Then, every two months, Tong brings in the actual games, and the residents compete against each other using the robotic arm in place of their own hands. For instance, they used the Hasbro Perfection game, designed for kids ages 5 and up, to work on wrist articulation. The fast-paced puzzle involves fitting shapes into their matching holes before time is up and the pieces pop out.
“We’re sitting at the robot using real instruments,” Tong said. “They may have perfected those simulator games. But when you’re actually holding the needle with the robotic instrument, it’s very different.” Ultimately, she said, “when they’re ready to perform those skills on an actual patient, it’s not their first time.”
Even though the gaming sessions aren’t mandatory, “almost all residents participate.” That, she said, “says a lot about the program’s success.”
The residents aren’t the only ones playing with ‘Tater Bot,’ which the surgical robot was named following a hospital-wide naming contest. Two patients, who underwent surgery with the device, have also had a chance to play the games. Tong brought in some hospital administrators to play with the new equipment, as well.
The two most challenging skills to learn are spatial awareness and manipulating tissue so it doesn’t tear. “One of the harder things to grasp with the robot is tactile feedback,” Tong said. “You just don’t know how hard you’re pulling because it isn’t the same as having your hand in there. But with practice, you learn how to be gentler. But that takes a really long time to master.”
Most residents won’t complete their first robotic surgery on a real patient until the end of the five-year program. “They have to prove that they understand the advantages and the shortcomings of the robot in order to be a safe and competent surgeon,” Tong said. “It’s essentially practice, practice, practice.”
[i] Nakamoto K, Jones DB, Adra SW. Gamification of robotic simulation to train general surgery residents. Surg Endosc. 2023 Apr;37(4):3136-3144. doi: 10.1007/s00464-022-09520-3. Epub 2022 Aug 10. PMID: 35947198.