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Trends in the Fundamentals of Laparoscopic Surgery® (FLS) certification exam over the past 9 years

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Abstract

Background

The Fundamentals of Laparoscopic Surgery® (FLS) certification exam assesses both cognitive and manual skills, and has been administered for over a decade. The purpose of this study is to report results over the past 9 years of testing in order to identify trends over time and evaluate the need to update scoring practices. This is a quality initiative of the SAGES FLS committee.

Methods

A representative sample of FLS exam data from 2008 to 2016 was analyzed. The de-identified data included demographics and scores for the cognitive and manual tests. Standard descriptive statistics were used to compare trends over the years, training levels, and to assess the pass/fail rate.

Results

A total of 7232 FLS tests were analyzed [64% male, 6.4% junior (postgraduate year—PGY1–2), 84% senior (PGY3–5), 2.8% fellows (PGY6), and 6.7% attending surgeons (PGY7)]. Specialties included 93% general surgery (GS), 6.2% gynecology, and 0.9% urology. The Pearson correlation between cognitive and manual scores was 0.09. For the cognitive exam, there was an increase in scores over the years, and the most junior residents scored the lowest. For the manual skills, there were marginal differences in scores over the years, and junior residents scored the highest. The odds ratio of PGY3+ passing was 1.8 (CI 1.2–2.8) times higher than that of a PGY1–2. The internal consistency between tasks on the manual skills exam was 0.73. If any one of the tasks was removed, the Cronbach’s alpha dropped to between 0.65 and 0.71, depending on the task being removed.

Conclusion

The cognitive and manual components of FLS test different aspects of laparoscopy and demonstrate evidence for reliability and validity. More experienced trainees have a higher likelihood of passing the exam and tend to perform better on the cognitive skills. Each component of the manual skills contributes to the exam and should continue to be part of the test.

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Acknowledgements

We would like to thank Carla Bryant, Christelle Menetrier, and all of the SAGES FLS staff for their help in conducting this study.

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Authors and Affiliations

  1. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada

    Elif Bilgic, Pepa Kaneva & Melina C. Vassiliou

  2. Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada

    Allan Okrainec

  3. Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD, USA

    E. Matthew Ritter

  4. Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA

    Steven D. Schwaitzberg

  5. Montreal General Hospital, McGill University Health Centre, 1650 Cedar Avenue, L9-313, Montreal, QC, H3G 1A4, Canada

    Melina C. Vassiliou

Authors
  1. Elif Bilgic
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  2. Pepa Kaneva
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  3. Allan Okrainec
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  4. E. Matthew Ritter
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  5. Steven D. Schwaitzberg
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  6. Melina C. Vassiliou
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Corresponding author

Correspondence to Melina C. Vassiliou.

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Disclosures

This is a quality initiative of the SAGES FLS committee. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation received an unrestricted educational grant from Covidien Canada. Elif Bilgic, Pepa Kaneva, Allan Okrainec, E. Matthew Ritter, Steven D. Schwaitzberg, Melina C. Vassiliou have no conflicts of interest or financial ties to disclose.

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Bilgic, E., Kaneva, P., Okrainec, A. et al. Trends in the Fundamentals of Laparoscopic Surgery® (FLS) certification exam over the past 9 years. Surg Endosc 32, 2101–2105 (2018). https://doi.org/10.1007/s00464-017-5907-0

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  • DOI: https://doi.org/10.1007/s00464-017-5907-0

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