International Journal of Computer Assisted Radiology and Surgery https://doi.org/10.1007/s11548-021-02545-4 ORIGINAL ARTICLE Does quality assured eLearning provide adequate preparation for robotic surgical skills; a prospective, randomized and multi-center study Stefano Puliatti 1,2,3,14 · Marco Amato 1,2,3 · Rui Farinha 1,2 · Artur Paludo 1,2,13,14 · Giuseppe Rosiello 1,2,4 · Ruben De Groote 1,2 · Andrea Mari 9 · Lorenzo Bianchi 11,12 · Pietro Piazza 1,2,11 · Ben Van Cleynenbreugel 6 · Elio Mazzone 4 · Filippo Migliorini 7 · Saverio Forte 8 · Bernardo Rocco 10 · Patrick Kiely 1,11 · Alexandre Mottrie 1,2 · Anthony G. Gallagher 1,5,6 Received: 2 August 2021 / Accepted: 10 December 2021 © CARS 2022 Abstract Purpose In particular after the onset of the COVID-19 pandemic, there was a precipitous rush to implement virtual and online learning strategies in surgery and medicine. It is essential to understand whether this approach is sufficient and adequate to allow the development of robotic basic surgical skills. The main aim of the authors was to verify if the quality assured eLearning is sufficient to prepare individuals to perform a basic surgical robotic task. Methods A prospective, randomized and multi-center study was conducted in September 2020 in the ORSI Academy, International surgical robotic training center. Forty-seven participants, with no experience but a special interest in robotic surgery, were matched and randomized into four groups who underwent a didactic preparation with different formats before carrying out a robotic suturing and anastomosis task. Didactic preparation methods ranged from a complete eLearning path to peer-reviewed published manuscripts describing the suturing, knot tying and task assessment metrics. Results The primary outcome was the percentage of trainees who demonstrated the quantitatively defined proficiency bench- mark after learning to complete an assisted but unaided robotic vesico-urethral anastomosis task. The quantitatively defined benchmark was based on the objectively assessed performance (i.e., procedure steps completed, errors and critical errors) of experienced robotic surgeons for a proficiency-based progression (PBP) training course. None of the trainees in this study demonstrated the proficiency benchmarks in completing the robotic surgery task. Conclusions PBP-based e-learning methodology is an effective training method avoiding critical errors in the suturing and knotting task. Quality assured online learning is insufficient preparation for robotic suturing and knot tying anastomosis skills. Trial registration ClinicalTrials.gov Identifier: NCT04541615. Keywords Surgical training · Proficiency-based progression · Metrics · eLearning Introduction The outbreak of COVID-19 has had a profound and almost certainly enduring impact on how health care profession- als work, interact, are educated, and trained [1]. It impacts probably most on trainees in procedure-based interventional disciplines such as surgery and in particularly involving the use of advanced technologies, e.g., surgical robotics, to perform the procedure. In response, there appears to be B Stefano Puliatti stefanopuliatti@gmail.com Extended author information available on the last page of the article a precipitous rush to implement virtual and online learn- ing strategies in surgery and medicine [2, 3]. There are no good arguments against the value of virtual and elearning approaches to support education and training in medicine. The function of these technologies should however be to augment and support conventional education and training activities [4]. For example, eLearning should be used to pre- pare a learner for a practical skills training course in which they are about to engage. Such an approach prior to attending the course ensures that the trainee knows what to do, how to do it and with which devices [5]. On the course the trainer has quantitative evidence that the trainee has this knowledge and can therefore concentrate their efforts on supervising 123