Digital transformation of robotic surgery train the trainer 'TTT' courses: training the trainer in technique and technology (the 4Ts course).

As the role of robot-assisted surgery continues to expand there has been as an associated proliferation of novel technologies to aid training. Necessitating the development of standardised and validated training programmes that incorporate guidance on curriculum development with training techniques, and where and when to utilise novel training technologies. To provide guidance on an optimised "Train-the-Trainer in Technique and Technology" (4Ts) structured educational programme for surgical trainers, in which delegates learn a standardised approach to training candidates in knowledge and skills acquisition both for surgery and the utilisation of novel training technologies. We aim to describe a 4Ts course for robotic surgery based on the current published literature and to define the key elements within a 4Ts course by seeking consensus from an expert committee formed of key opinion leaders in training and MedTech industry. The project was carried out in phases: a systematic review of the current evidence was conducted, a hybrid meeting was held, and an initial survey was created based on the current literature and expert opinion and sent to the committee. Twenty experts in robotic training, contributed to the Delphi process that included clinicians, academics, and industry representing nine different surgical specialties and seven different robotic companies. An accelerated Delphi process underwent three rounds of survey in total. Additions to the second- and third-round surveys were formulated based on the answers and comments from the previous rounds. Consensus opinion was defined as 80% agreement. There was 100% consensus that there was a need for a standardized platform agnostic 4Ts course in robotic surgery. A consensus was reached in multiple areas, including the following: (1) definitions and terminologies, (2) qualifications to attend, (3) course objectives, (4) pre-course considerations, (5) requirements of e-learning, (6) theory and course content, and (7) measurement of outcomes and (8) performance certification and regulation. The resulting formulated curriculum showed good internal consistency among experts, with a Cronbach alpha of 0.90. An evidence-based consensus has been achieved to reach content validation for guidance on a 4Ts curriculum for robotic surgery training. This recommended content lays the foundation for developing platform agnostic metric-based progression curricula for trainers in robotic surgery. Future 4Ts curricula related to procedural training will require further validation. As the role of robot-assisted surgery continues to expand, development of standardised and validated training programmes is becoming increasingly important. There is currently a lack of agreement on how best to train trainers in both training and awareness of novel training technologies. We report a consensus view on a standardised "4Ts" curriculum focused on robotic surgery. It was formulated by polling the opinions of experts and industry, combining current evidence for training technologies with experts' knowledge of surgical training.