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Weighing in here with the caveat that our fellowship uses CSATS for Objective Skills Assessment. In general, we divide the cases into critical steps that confer outcomes. For example: Pyeloplasty – Exposure of UPJ, Fixation of Pelvis (hitch stitch), division and spatulation of pelvis/ureter, posterior anastomosis, anterior anastomosis, (and if resident involved – closure of mesenteric window). For Reimplant – ureteral mobilization, dissection from under uterine artery (female), bladder hitch if desired, detrusor tunnel (detrusorotomy), anchoring and advancement of ureter, closure of tunnel (detrusorrhaphy)
These steps are analyzed by CSATS and also by me in the OR. From the progress the fellows make through each of these steps, I determine to which steps they graduate next. For pyeloplasty, usually the exposure and posterior anastomosis is the last thing the fellows learn to do because I believe these two steps set the tone for success.
For reimplant, the detrusor flap creation and the advancement stitch are the last steps the fellows learn independence on.
If you wanted to get objective scoring data without CSATS, just download Alvin Goh’s paper on GEARS (Global Evalautive Assessment of Robotic Skills) J Urol paper. This will give you a common language with which you can score your trainees.
Goh AC, Goldfarb DW, Sander JC, Miles BJ, Dunkin BJ. Global evaluative assessment of robotic skills: validation of a clinical assessment tool to measure robotic surgical skills. The Journal of urology. 2012 Jan 31;187(1):247-52.