The revolution in operating rooms around the world is no longer a vision of the future, but the present. Robotic surgery, the technological pinnacle of modern medicine, is experiencing exponential growth and becoming the standard in numerous medical disciplines. By providing surgeons with unprecedented precision, control, and visualization, this technology is transforming the performance of complex procedures. Using sophisticated systems like the Da Vinci platform, surgeons operate robotic arms with exceptional dexterity, performing minimally invasive procedures that result in smaller incisions, reduced blood loss, shorter hospital stays, and faster patient recovery. In the United States alone, approximately 2.63 million such procedures were performed during 2024, representing an increase of nearly 20% compared to the previous year. However, with this rapid technological ascent comes a key challenge: how to adequately educate the new generation of surgeons to work in this high-tech environment? At the University of California, San Francisco (UCSF), one of the pioneers in this field, they have found an innovative and unique answer to this question.

In the heart of the Surgical Skills Laboratory at UCSF, surgery resident Dr. Alan Zambeli-Ljepovic sits at a console reminiscent of a sophisticated arcade game. His fingers are precisely inserted into the control loops, and his feet rest on the pedals. With a flick of his wrist, the nearly six-foot-tall surgical robot next to him comes to life. From a distance, Dr. Zambeli-Ljepovic controls four massive robotic arms. One wrist movement is enough for the arm equipped with a scalpel to make a precise incision on a liver, procured from a local butcher shop for practice. A touch of the foot on a pedal activates electricity for cauterization. His only window into the surgical field is a high-resolution camera mounted on one of the robotic arms, which provides a magnified, three-dimensional view. He cannot directly see the robotic arms moving in millimeter proximity to each other. That crucial supervision is the responsibility of Dr. Hueylan Chern, the lab's director and a professor of surgery, who today is providing one-on-one instruction to the residents. "Think about how you're going to use your static arm to set up this cut," she advises him. "When I operate, I know almost every step in advance: I know what the first arm will do, what the second will do."

Overcoming the Education Gap

Robotic-assisted surgery is booming in fields like urology, gynecology, and gastrointestinal procedures, and its application will only expand. The technology allows surgeons to work in extremely confined spaces within the body, leading to less invasive procedures and faster patient recovery. However, the traditional model of surgical education, centuries old, is encountering obstacles. Medical students have always learned by standing at the operating table, observing and assisting. In the world of robotic surgery, the lead surgeon is physically separated from the patient, situated at a console. The area around the table becomes crowded – anesthesiologists, nurses, technicians, and assistants share the space with a robot nearly one meter wide. In this new layout, as Dr. Chern noted, there was simply no more room for medical students. "The trainees are physically separated from the surgical team. We noticed they weren't sure where they were supposed to be; sometimes they would just sit in a corner and watch the feed on a screen," Chern explains. "They just didn't feel included."

To bridge this gap, Dr. Chern and medical students at UCSF co-developed the first program of its kind in the world. It involves certifying final-year medical students for the role of a bedside assistant during robotic surgeries. This role is crucial for the safe and efficient performance of the procedure. Once trained, assistants position the robot before and after surgery, change surgical instruments on the robotic arms, and help ensure the robot's many arms move safely alongside each other during the procedure. This program offers medical students unparalleled insight into the technology shaping the future of surgery, thereby significantly increasing their competitiveness when applying for prestigious residency programs.

From Observer to Active Participant: Developing an Innovative Program

Surgery resident Dr. Anya Edwards, who graduated in 2023, remembers her student days of observing robotic surgeries well. "Sometimes I wouldn't even prepare for the surgery, I would just sit on the side," she recalls. "I never felt integrated because I didn't have a defined role." As a student in 2021, Edwards, in collaboration with Dr. Chern and the Surgical Laboratory, developed and piloted a simulation curriculum for students. The program combined online learning with hands-on practice on the robot. The program's design also involved Dr. Adnan Alseidi, Associate Dean of the School of Medicine, Dr. Patricia O'Sullivan, Director of Research in Medical Education, and Dr. Shareef Syed, an associate professor of surgery. The 2021 pilot project was an outstanding success. Research conducted by Edwards with the professors in 2023 showed that nearly all participating students stated that the program better prepared them for their surgical rotations and entry into the world of surgery.

That successful pilot became the foundation for the official assistant certification program, which was further developed by Dr. Chern and Dr. O'Sullivan, along with surgery residents and lab educators, Dr. Camilla Gomes and Dr. Alyssa Murillo. "I am grateful for the culture at UCSF that promotes this kind of openness and allows students to take on this role as part of their education," Dr. Gomes points out.

Certification Structure: The Path to the Operating Room

The certification program for bedside assistants is carefully structured to ensure both high-quality education and maximum patient safety. The process begins with an online module that introduces students to the robot, its numerous buttons, arms, and pedals. Afterward, Dr. Gomes and Dr. Murillo lead small groups of students through hands-on exercises. In the lab, they learn to manipulate the robotic arms, change instruments, and clean the camera. Upon completing this part of the training, students receive a sticker with a cartoon robot to put on their ID badges. This sticker signals to the staff in the UCSF operating rooms at the Parnassus and Mission Bay campuses that the student is a certified assistant. Although they can then begin to participate in surgeries, their entry into practice is gradual. Initially, they work in pairs with experienced assistants during a series of procedures before taking on the role of primary assistant. Throughout the entire process, trainees receive weekly emails with progress checks and feedback from the surgeons and teams they have worked with. This cautious approach strikes a balance between providing exceptional educational opportunities and uncompromising patient safety.

A Competitive Edge for Future Surgeons

So far, more than a dozen students have successfully completed the program and become certified assistants. Many of them emphasize that this experience has strengthened their interest in robotic surgery and made them significantly more competitive candidates for reputable residency programs. Jessica Santhakumar, a medical student and certified assistant, dreams of collaborating with the surgical device industry after becoming a surgeon. She earned her certificate in April and has since assisted in more than a dozen robotic surgeries. "It was very scary at first, but our instructors warned us that we would be nervous and encouraged us to do our best and ask for help when we needed it," she recalls. "I just approached the scrub nurse and told her it was my first or second time assisting and that I would love to learn from her. The whole team set me up for success." Today, Santhakumar regularly participates in surgeries at the Helen Diller Medical Center at Parnassus Heights. "I encourage all my friends who are applying for a general surgery residency to go through this training because it really helps us stand out in our rotations," she adds.

In July of this year, Dr. Chern received the highest national recognition in the field of surgical education for this innovative program, with her induction into the American College of Surgeons Academy of Master Surgeon Educators. This achievement confirms UCSF's position as a national leader, not only in the application but also in the teaching of robotic surgery. "What is truly wonderful about this work is the contribution that I, as a student, and other students had in creating this curriculum, because it is ultimately intended for students," says Dr. Edwards. "It is a beautiful example of designing a program together with the people it is intended for."