Ensuring Competency: Is Fls Certification Necessary for Practicing Surgeons?

Daniel J Scott, MD, Melanie Hafford, MD, Ross E Willis, PhD, Kristine Gugliuzza, MD, Todd D Wilson, MD, Kimberly M Brown, MD, Kent R Vansickle, MD. UT Southwestern Medical Center at Dallas, UT Health Science Center at San Antonio , UT Medical Branch at Galveston, UT Houston Medical Center


Background: Certification in the Fundamentals of Laparoscopic Surgery (FLS) is required by the American Board of Surgery for graduating residents. The purpose of this study was to evaluate the feasibility and potential need for certifying practicing surgeons.

Methods: Through a patient safety and healthcare delivery effectiveness grant, investigators at 4 state medical schools received funding to cover expenses associated with FLS certification of all attending general surgeons (n=89, GS) credentialed in laparoscopy, as mandated by each chairman of surgery; extra vouchers were used for gynecologists (n=8, GYN) and urologists (n=3). Data were voluntarily collected under an IRB-approved protocol at each institution. Each participant performed a single repetition of all 5 FLS tasks scored (time and errors) by FLS test center proctors, followed by review of their score, orientation to the FLS proficiency-based curriculum, and encouragement of further skills practice at their own discretion. Participants were also oriented to the online cognitive FLS materials and encouraged to self-study. Two months later, the certification exam (skills and cognitive) was administered under standard testing conditions. Baseline and completion questionnaires were administered. Comparison of baseline and final skills performance were compared using signed-rank tests.

Results: Only one surgeon refused data collection. Of 99 enrolled participants (13.7 ± 10.6 years in practice), 76 completed all portions of the curriculum (77% compliance), including certification; institution-specific compliance was 35%, 77%, 79%, and 100% and varied according to the extent of chairman enforcement. Of 87 participants who completed the baseline skills assessment, 22 (25.3%) failed to achieve a passing score; institution-specific baseline skills failure rates were 0%, 21%, 24%, and 46%. After an overall self-reported practice time of 2.5 ± 2.3 hours, 76 participants completed certification. Skills performance improved for all 5 tasks (p<0.0001) and according to the overall score (310 ± 95 vs. 428 ± 93, p<0.0001); self-rated comfort (5-point scale) performing basic laparoscopic operations increased from 4.0 ± 1.0 to 4.6 ± 0.6 (p<0.002). At certification, 1 (1.3%, GS) failed the skills exam and 8 (10.5%, 7 GS, 1 GYN) failed the cognitive exam; remediation was completed by 6 of these 9 individuals with subsequent successful certification.

Conclusions: This study demonstrates that FLS certification for practicing surgeons is feasible given appropriate financial and institutional support. Moreover, a baseline skills failure rate of 25.3% and a certification failure rate of 11.8% suggest that FLS certification may be necessary for ensuring competency according to objective metrics. Fortunately, with only moderate practice, significant improvement can be achieved.

Session Number: SS13 – Simulation
Program Number: S076

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