Randomised trial on the economic impact of proficiency‐based progression vs conventional robotic surgical training

OBJECTIVE: To evaluate the cost-effectiveness of proficiency-based progression (PBP) training compared to conventional surgical training approaches, and to determine whether PBP training implementation is economically justified when scaled to large numbers of trainees. METHODS: Economic analysis was performed using data from the prospective, randomised, and blinded Orsi Surgical Skills E-learning Trial (OSSET; ClinicalTrials.gov identifier: NCT04541615) at ORSI Academy (Belgium), where 47 medical trainees without prior robotic surgery experience were randomised into four groups, each with progressively reduced adherence to the PBP methodology. All trainees completed simulation-based training on a validated bladder-urethra anastomosis model, ranging from full PBP training with metric-based assessment and proficiency benchmarks (Group 1) to a traditional apprenticeship model (Group 4). The primary outcome was training cost, evaluated per trainee and based on programme scalability (12-500 trainees), including expenses for accommodation, laboratory time, and metric development. Cost equivalence points and scalability thresholds were identified to compare the financial impact of the four training strategies. RESULTS: The PBP training was more expensive than conventional methods for small cohorts (e.g. €14 139 vs €7067 per trainee for 12 trainees), but became significantly more cost-effective beyond 25 trainees (equivalence point). At 500 trainees, total PBP training cost was €1.69 million compared to €3.53 million for conventional training, a 110% cost advantage. All differences were statistically significant (P < 0.001). CONCLUSIONS: We conclude that PBP training is significantly more effective and becomes increasingly cost-efficient as the number of trainees increases. These findings support its integration into high-volume national training programmes, offering a scalable and economically sustainable alternative to apprenticeship-based surgical education.