Scott Daniel J, Ritter E Matt, Tesfay Seifu T, Pimentel Elisabeth A, Nagji Alykhan, Fried Gerald M
Southwestern Center for Minimally Invasive Surgery, Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9156, USA.
Surg Endosc. 2008 Aug;22(8):1887-93. doi: 10.1007/s00464-008-9745-y. Epub 2008 Feb 13.
The fundamentals of laparoscopic surgery (FLS) program has been extensively validated for use as a high-stakes examination for certification purposes, but optimal methods for its use in skills training have not been described. This study aimed to investigate the feasibility of implementing a proficiency-based FLS skills training curriculum and to evaluate its effectiveness in preparing trainees for certification.
For this study, 21 novice medical students at two institutions viewed video tutorials, then performed one repetition of the five FLS tasks as a pretest. The pretests were scored using standard testing metrics. The trainees next practiced the tasks over a 2-month period until they achieved proficiency for all the tasks. A modified on-the-fly scoring system based on expert-derived performance was used. The trainees were posttested using the high-stakes examination format.
No trainee passed the certification examination at pretesting. The trainees achieved proficiency for 96% of the five tasks during training, which required 9.7 +/- 2.4 h (range, 6-14 h) and 119 +/- 31 repetitions (range, 66-161 repetitions). The trainees rated the proficiency levels as "moderately difficult" (3.0 +/- 0.7 on a 5-point scale) and "highly appropriate" (4.7 +/- 0.1 on a 5-point scale). At posttesting, 100% of the trainees passed the certification examination and demonstrated significant improvement compared with pretesting for normalized score (468 +/- 24 vs 126 +/- 75; p < 0.001), self-rated laparoscopic comfort (89.4% vs 4.8%; p < 0.001), and skill level (3.6 +/- 0.9 vs 1.2 +/- 0.5; p < 0.001, 5-point scale).
This proficiency-based curriculum is feasible for training novices and uniformly allows sufficient skill acquisition for FLS certification. Endorsed by the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), this curriculum is available for use as an optimal method for FLS skills training. More widespread adoption of this curriculum is encouraged.
腹腔镜手术基础（FLS）项目已被广泛验证可作为用于认证目的的高风险考试，但尚未描述其在技能培训中的最佳使用方法。本研究旨在调查实施基于熟练程度的FLS技能培训课程的可行性，并评估其在使学员为认证做准备方面的有效性。
在本研究中，两所机构的21名医学新生观看了视频教程，然后作为预测试进行了一次五项FLS任务的操作。预测试使用标准测试指标进行评分。接下来，学员在两个月的时间里练习这些任务，直到他们对所有任务都达到熟练程度。使用基于专家表现得出的改进的即时评分系统。学员使用高风险考试形式进行后测试。
在预测试时没有学员通过认证考试。学员在培训期间对五项任务中的96%达到了熟练程度，这需要9.7±2.4小时（范围为6 - 14小时）和119±31次重复操作（范围为66 - 161次重复操作）。学员将熟练程度评为“中等难度”（5分制下为3.0±0.7）和“非常合适”（5分制下为4.7±0.1）。在后测试时，100%的学员通过了认证考试，并且与预测试相比，在标准化分数（468±24对126±75；p < 0.001）、自我评定的腹腔镜操作舒适度（89.4%对4.8%；p < 0.001）和技能水平（5分制下为3.6±0.9对1.2±0.5；p < 0.001）方面有显著提高。
这种基于熟练程度的课程对于培训新手是可行的，并且一致地允许学员获得足够的技能以通过FLS认证。该课程得到了美国胃肠内镜外科医生协会（SAGES）的认可，可作为FLS技能培训的最佳方法使用。鼓励更广泛地采用该课程。
