Introduction: The Certified Curriculum of ERUS (CC-ERUS) fellowship on robot-assisted radical prostatectomy (RARP) is almost 10 years old. To complete the CC-ERUS outcome-based fellowship, a video of a full RARP performed by the fellow must be assessed by an expert. The aim of the current study was to 1) understand and report the completion rate of the fellowship (i.e. achievement of the Certificate of Excellence award) and 2) identify reasons for non-completion. Methods: The CC-ERUS is a 6 months structured training program that includes an eLearning part, followed by one-week robotic skills course; then, trainees have 6 months of modular training at a host center. At the end of the fellowship, trainees are requested to submit a video of a full RARP performed by themselves. The video is objectively assessed by experts and, in case of positive assessment, the fellowship is completed and the fellow can receive the Certificate of Excellence. We analysed our prospectively collected data on all CC-ERUS fellows. We then conducted a telephone survey on 2018-2021 CC-ERUS fellows to investigate the reasons for non-completion. Standardized interview format questions were used to conduct the survey. Results: Data on 87 subjects enrolled in the fellowship between were collated. While all subjects successfully completed the 1-wk robotic skills course, only 26 (30%) fellows achieved the certificate of excellence. The completion rate by year was 20% in 2018, 29% in 2019, 36.4% in 2020, and 31.4% in 2021. Therefore, the COVID-19 pandemic had only a modest impact on completion rate. The response rate to the telephone interview survey was 77%. The following reasons for non-completion emerged: insufficient console exposure (49%), insufficient fellowship duration (20%), COVID-19 pandemic (11%), logistic difficulties in submitting the video (20%). Conclusions: The CC-ERUS for RARP was the first validated robotic curriculum in the world, and still one of the very few outcome-based fellowships. Nonetheless, we observed a low completion rate that needs to be addressed with appropriate actions. To increase the fellowship completion rate, three solutions should be considered by the ERUS board: 1. Review of the Host Centers, to exclude those which do not meet the certification criteria (e.g. insufficient console time for fellows) 2. Periodical Train-The-Trainers courses for the mentors at host centers 3. Follow-up procedural diary: the fellows will be requested to submit videos of each phase while progressing in their modular training and self-assess their performance using validated RARP metrics. SOURCE OF Funding: None
