Discussion
Given the need to provide practice opportunities to prepare learners to use new surgical technologies, this study evaluated home practice for robotic surgery. Overall, low-cost robotic surgery home simulation kits did not lead students to better performance on dVSS compared to control students, though interview data highlighted the potential of home simulation and future directions for simulator development. The score increase in both groups between simulation sessions likely reflects task familiarity on dVSS gained during the first session. Challenges with physical fidelity of the home robotic simulation kits, as discussed by many participants in interviews, may have limited additional skill gains in the home practice group. Furthermore, many participants did not meet the practice goal, likely because home practice was unsupervised and unscheduled. Additionally, the duration of practice was self-reported, which may have been inaccurate and did not account for how correctly the participants practiced. Finally, since medical students are not expected to perfect their robotic surgical skills, they may have less motivation to practice compared to, for example, surgical residents who will be expected to master these skills.For future iterations of the home simulation kit, participants noted the importance of addressing the haptics of the model and choosing appropriate practice tasks. While this feedback from medical students will be important in planning future studies, it would also be helpful to include surgical residents with more experience in further trials. Prior experience with the robot may allow trainees to focus home practice on the most useful skills, while also practicing with better technique, leading to greater overall improvement.There remains a need for a low-cost simulation model to facilitate engagement and accessible practice for robotic surgery. Many trainees do not have formal robotic surgery simulation training curricula in place at their institutions [This study begins to address this need by describing important considerations for low-cost robotic simulator development. Improvements to model design transferability, such as fine-tuning the resistance of the controllers or including a clutch, could potentially lead to more efficacious practice and greater improvements in performance. It was apparent that a number of students in the experimental group showed strong motivation to practice their skills with the home simulation kits. Some students spent several hours practicing with the home kits and found them to be an excellent way to engage with robotic surgical skills. Having additional time to practice at home can be an important component of learning when there is limited student exposure to robotic surgery [In conclusion, the home simulation kits will need to be further refined to better represent the robotic surgery controllers and the practice tasks should be modified to optimize user skill acquisition in the future. However, work with home simulation kits represents the beginning of a needed innovation in robotic surgery. The development of creative, low-cost solutions to practice surgical techniques is essential to reach more potential trainees and foster more inclusive and accessible surgical education.