Data-based Self-study Guidelines for the Fundamentals of Laparoscopic Surgery Examination

Maria A Cassera, BS, Bin Zheng, MD PhD, Lee L Swanstrom, MD. Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic


The goal of this study is to analyze residents’ performance on the Fundamentals of Laparoscopic Surgery (FLS) manual skills tasks following the American Board of Surgery mandate in 2010, and provide a set of self-study reference guidelines for residents to optimize chances of passing the manual skills test.

The FLS program is frequently used for teaching and assessing the competence of surgical residents involved with laparoscopic procedures. The cognitive component of FLS teaches knowledge and problem-solving skills, and the manual skills component measures performance of laparoscopic tasks. In 2010, the American Board of Surgery mandated that all general surgery residents pass the FLS examination in order to qualify for the American Board of Surgery Certifying Examination. In preparing for the FLS test, residents usually adopt a self-learning strategy where practice time can be managed with more flexibility. However, with this self-learning strategy they lack guidance from experts and risk understudying for their high-stakes exam.

The goal of this project is to use the data from the first year of mandated examination to determine study goals for self-guided practice of the FLS manual skills tasks that will predict success with the examination.

The FLS manual skills score sheets for all PGY-5 residents in 2010 were supplied by the FLS Administrative Office. Score sheets list the time and accuracy of each of the 5 components of the exam, and descriptive statistics were conducted on the results of these tests. Data was then grouped by the pass/fail results of the exam, and the minimal time requirement for passing each skill test was reported for guiding practice.

In 2010, a total of 1048 proctored FLS tests were completed by PGY-5 residents. The mean task times achieved by all residents for the peg transfer was 84 ± 31 seconds, pattern cut was 139 ± 54 seconds, endoloop was 78 ± 29 seconds, extracorporeal suturing was 158 ± 66 seconds and intracorporal suturing was 168 ± 77 seconds. In the pass group (N = 988), the mean times to complete the peg transfer was 80 seconds, pattern cut was 134 seconds, endoloop was 75 seconds, extracorporeal suturing was 148 seconds and intracorporal suturing was 160 seconds. The suggested self-study goal for each test is 53 seconds for peg transfer, 86 seconds for pattern cut, 50 seconds for endoloop, 99 seconds for extracorporeal suturing, and 95 seconds for intracorporeal suturing. If a resident can reliably achieve these results during self-study, they will have an 84% chance of passing the exam.

Residents who are preparing to take the FLS test can refer to data presented in this study to set their practice goals. Having data based practice goals will help residents to improve the chances of passing their high-stakes FLS exams.

Session Number: SS05 – Education
Program Number: S026

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