The last several years have seen the use of robotic surgery grow dramatically across disciplines. As research on outcomes, costs, and other data continue to grow, it is important for surgical educators to understand a baseline issue—appropriate credentialing and privileging for robotic surgery.
In Sunday’s Special Session, “Credentialing and Privileging in Robotic Surgery—Current State and Future Opportunities,” expert panelists discussed their experience with growing robotic surgery practices at their institutions and the need to formalize robotic surgery skill.
Providing a perspective on surgical education principles, Ajit K. Sachdeva, MD, FACS, Senior Vice President of the ACS Division of Education and a co-founder of the Academy, discussed the various frameworks used by the ACS to ascertain a trainee’s level of proficiency in skills such as robotics.
“Privileging is certainly local, but credentialing is a shared responsibility,” Dr. Sachdeva said.
With hospitals looking for guidance on privileging, the experience of surgical educators within hospitals can provide some useful lessons.
To that end, Alisa M. Coker, MD, FACS, an associate professor and director of robotic surgery and education for the Dell Medical School Department of Surgery and Perioperative Care at The University of Texas at Austin, began her talk with a useful metaphor on the difference between credentialing and privileging—terms that are often used interchangeably, and also incorrectly.
“Credentialing is access to the garage—the key that allows you access to the cars, but you can’t drive them yet,” she said, adding that its purpose is to verify you belong with your education, training, licensure, and so on. Meanwhile, “privileging is the key to the specific cars, authorizing the procedure or services you can perform.”
Dr. Coker followed by describing her role in building a robotic credentialing program at Johns Hopkins, her former institution. The journey, she said, did not begin with immediate buy-in from her chair for their initial credentialing document—in fact, it was rejected. Leadership wanted to avoid new bureaucracy and let departments retain discretion on credentialing and privileging.
Surgeons at Johns Hopkins continued to use robotic platforms and build experience in the meantime, and then a few years later, there was breakthrough in implementing a credentialing process—though the impetus was perhaps anticlimactic.
“What changed? Our malpractice carrier came to us and said, ‘If you don’t have a robotic credentialing policy of any type, we’re not going to cover robotic cases,’” Dr. Coker said, adding that increasing use of robotics was leading to plaintiffs probing training and privileges during discovery.
She went on to discuss that, regardless of why the decision is made to pursue a credentialing process, surgeon leadership is essential in order to retain clinical ownership, keep end-user expertise paramount, and ensure safety takes precedence over politics.
“If it’s not us, someone else is going make policy, and it’s often going to be someone without any clinical expertise at all,” she said.
