E. Matthew Ritter, MD1, Zachary A Taylor, DO1, Kathryn R Wolf, MD1, Brenton R Franklin, MD1, Sarah B Placek, MD1, James R Korndorffer, MD2, Aimee K Gardner, PhD3. 1Uniformed Services University/Walter Reed Department of Surgery, Division of General Surgery & National Capital Region Simulation Consortium, Bethesda MD, 2Department of Surgery, Tulane University School of Medicine, New Orleans LA, 3University of Texas Southwestern Medical Center at Dallas, Dallas TX
INTRODUCTION: The Fundamentals of Endoscopic Surgery (FES) program has considerable validity evidence for its use in measuring the knowledge, skills and abilities required for competency in endoscopy. Beginning in 2018, the American Board of Surgery will require all candidates to have taken and passed the written and performance exams in the FES program. Recent work has shown that the current ACGME/ABS required case volume may not be enough to ensure trainees pass the FES skills exam. The aim of this study was to investigate the feasibility of a simulation based mastery-learning curriculum delivered on a novel physical simulation platform to prepare trainees to pass the FES manual skills exam.
METHODS: The newly developed Endoscopy Training System (ETS) was used as the training platform. Thirteen PGY 1 (10) and PGY 2 (3) general surgery residents completed a pre-training assessment consisting of all 5 FES tasks on the GI Mentor II. Subjects then trained to previously determined expert performance benchmarks on each of 5 ETS tasks. Once training benchmarks were reached for all tasks, a post training assessment was performed with all 5 FES tasks.
RESULTS: Two subjects were lost to follow up and never returned for training or post-training assessment. One additional subject failed to complete any portion of the curriculum, but did return for post-training assessment. The group had minimal endoscopy experience (median 0, range 0 – 27), and no prior simulation experience. One trainee (7.7%) achieved a passing score on the pre-training FES assessment. Training consisted of an average of 48 +/- 32 repetitions on the ETS platform. distributed over 5.6 +/- 2 training sessions. 70% achieved proficiency on all 5 ETS tasks. There was dramatic improvement demonstrated on the mean post-training FES assessment when compared to pre-training (73.7 +/- 9 vs. 43.9 +/- 13, p< 0.0001, effect size = 2.7). The number of ETS tasks trained to proficiency correlated moderately with the score on the post training assessment (r=0.55, p=0.043). Ten (100%) subjects who trained to proficiency on at least one ETS task passed the post-training FES manual skills exam.
CONCLUSIONS: This Simulation Based Mastery Learning curriculum using the ETS is feasible for training novices and allows for the acquisition of the technical skills required to pass the FES manual skills exam. This curriculum should be strongly considered by programs wishing to ensure that trainees are prepared for the FES exam.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79070
Program Number: S038
Presentation Session: Panel: Meeting the ABS Mandate – The Program Director’s Guide to the FEC Galaxy
Presentation Type: Panel