Validity of Using the Fundamentals of Laparoscopic Surgery (fls) Program to Assess Laparoscopic Competence Among Gynecologists

Introduction: The Fundamentals of Laparoscopic Surgery (FLS) program has been accepted as a valid tool for assessment of basic laparoscopic skills among general surgeons. This study is designed to investigate the validity of using the FLS program for assessing cognitive and psychomotor laparoscopic skills among gynecologists.

Methods: A total of 45 gynecologists with variable surgical training and laparoscopic experience were enrolled for FLS testing. Each test included a cognitive computer-based exam to assess one’s knowledge and a psychomotor portion to assess one’s manual skills. A pre-test survey was used to document each participant’s surgical training level and extent of surgical experience specific to laparoscopic procedures. Participants were asked to self-rate their confidence for performing laparoscopic procedures. Upon completion of the test, feedback on the FLS program was obtained from all participants.

Results: 38 individuals completed the FLS test. Gynecologists with more advanced levels of surgical training achieved higher FLS manual skills scores than those who had lower levels of surgical training (Attending: 528; Fellow: 491, senior resident: 491, junior resident: 336. P = 0.007). In contrast, the FLS cognitive scores did not correlate to one’s level of surgical training (Attending: 333; Fellow: 391, senior resident: 413, junior resident: 362. P = 0.468). Self-rated confidence scores correlated well with FLS manual skills test scores (r = 0.53), but only moderately with the cognitive scores (r = 0.16). Regression analyses support that FLS manual skill scores better reflect one’s experience specifically in laparoscopic surgery (years in practice and number of laparoscopic cases performed) rather than one’s general surgical experiences in gynecology. In contrast, the FLS cognitive score does not correlate with one’s laparoscopic experience or level of surgical training.

Conclusion: The FLS program is a valuable and promising assessment tool for gynecologists. The manual skills component of the FLS test appropriately measures the level of a gynecologic surgeon’s psychomotor skills. The FLS cognitive test portion however poses challenges to gynecologists, and does not discriminate between advanced and novice surgeons. Modifications of the FLS cognitive test may allow better adaptability of the FLS program to be applied to gynecologic laparoscopists.

Session: Podium Presentation

Program Number: S113

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