Section of Minimally Invasive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
Surg Endosc. 2010 Mar;24(3):616-23. doi: 10.1007/s00464-009-0617-x. Epub 2009 Aug 18.
Fundamentals of Laparoscopic Surgery (FLS) is a validated program developed by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) to educate and assess competency in minimally invasive surgery (MIS). This study reports the first malpractice carrier-sponsored FLS course for surgeons in practice underwritten by the Controlled Risk Insurance Company of Harvard's Risk Management Foundation (CRICO/RMF). The study investigated the participating surgeons' pattern of MIS skills acquisition, subjective laparoscopic comfort level, operative activity, and perception of the FLS role in surgical education, credentialing, and patient safety.
A 1-day postgraduate continuous medical education (CME) course consisted of didactic presentations of the leading MIS faculty, proctored FLS hands-on training, psychomotor testing, and cognitive computer-based examination. Voluntary anonymous pre- and postcourse surveys were distributed to the participants at registration and at completion of both the didactic teaching and the skills modules of the program.
The course was attended by 37 practicing surgeons in the Harvard system, and 86% of the survey forms were returned. The major driving forces for attending the course were directive from the chief/chairman (50%), improvement in MIS didactic knowledge (56%), and the belief that FLS would become a standard such as advanced trauma life support (ATLS), advanced cardiac life support (ACLS), or the like (53%). Surgeons reported that the FLS exam content was appropriate (Likert 4.41 +/- 0.91) and that mastery of the course material would improve safety (Likert 4.13 +/- 0.79) and technical knowledge of MIS (Likert 4.03 +/- 1.00).
This unique cooperative effort between a liability carrier, a professional surgical society, and proactive surgeons should be considered a model for advancing competency and patient safety. The survey results indicate a positive view of FLS in surgical training, safety, and MIS education.
腹腔镜手术基础（FLS）是由美国胃肠内镜外科医师学会（SAGES）开发的一项经过验证的项目，旨在教育和评估微创外科（MIS）的能力。本研究报告了首个由哈佛风险管理基金会的受控风险保险公司（CRICO/RMF）承保的、面向执业外科医生的、由责任方赞助的 FLS 课程。该研究调查了参与外科医生的 MIS 技能获取模式、主观腹腔镜舒适度水平、手术活动以及对 FLS 在外科教育、认证和患者安全中的作用的看法。
为期 1 天的研究生继续医学教育（CME）课程包括由 MIS 主要教员进行的讲座、监督 FLS 实践培训、心理运动测试和基于计算机的认知考试。在注册时和课程的理论教学和技能模块完成时，向参与者分发了自愿匿名的课前和课后调查。
哈佛系统的 37 名执业外科医生参加了该课程，86%的调查问卷得以返回。参加该课程的主要驱动力是主任/主席的指示（50%）、提高 MIS 理论知识（56%），以及相信 FLS 将成为像高级创伤生命支持（ATLS）、高级心脏生命支持（ACLS）等标准（53%）。外科医生报告说 FLS 考试内容合适（Likert 4.41 +/- 0.91），并且掌握课程材料将提高安全性（Likert 4.13 +/- 0.79）和 MIS 的技术知识（Likert 4.03 +/- 1.00）。
责任方、专业外科医师学会和积极主动的外科医生之间的这种独特合作努力应被视为提高能力和患者安全的典范。调查结果表明，外科医生对 FLS 在外科培训、安全和 MIS 教育中的应用持积极看法。
