Feasibility of FLS Mastery Training Standards Applied to a Lower Cost, Ergonomically Differing Training Platform

Mercy D Wagner, MD1, Mary T O’Donnell, MD1, Kristen D Trinca, MD1, Eilliott Silverman, PAC2, E. Matthew Ritter1. 1WRNMMC, 2USUHS

Objective: Training for the FLS exam using the mastery learning based skills training curriculum results in exceedingly high pass rates for the FLS performance exam.  Cost for mastery learning using standard FLS equipment can be high.  We assessed the feasibility of applying the previously established mastery learning standards to a lower cost FLS training platform.

Methods:  22 subjects were randomized to either standard FLS (SF) training (n=12) or low cost FLS (LCF) training (n=10) groups.  After completing a pretest on the standard FLS box, each group trained on the peg transfer task to reach the previously established mastery learning score of 48 seconds with no transfer errors.  Each group underwent deliberate practice with the same coaches during multiple one to two hour sessions.  A maximum of 50 trials were completed by each group.

Results:  Despite being comparable in age, laparoscopic experience, gender, hand dominance, and FLS experience, the SF group outperformed the LCF group in mean baseline peg transfer score (60 +/- 21 vs. 24 +/-27, p = 0.005).  83% of the SF group reached the mastery learning standard at least once, while only 30% of the LCF group reached the standard (rr = 3.5, p = 0.04).  Of those who met the mastery standard, the mean number of trials required were not significantly different (25 +/-11, 19 +/-8, p = 0.61).  The average total repetitions for both groups was also similar (41 vs. 34, p = 0.55).  Despite differences at baseline, by trial 50, performance times improved and differences were no longer significant (48 +/- 3 sec vs. 67 +/-17 sec, p = 0.10).

Conclusions:  Despite starting with unexpected differences in baseline performance, learning curves on both training platforms were similar, showing convergence as expected in a mastery learning model.  While it appears that the previously established mastery learning standard may be more difficult to achieve for trainees using an ergonomically different platform, it is feasible in a number of trials not drastically different from the standard FLS platform.  These findings give us enough confirmation to proceed with previously established mastery based learning standards on the remaining FLS tasks.

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