Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
Surg Endosc. 2023 Aug;37(8):6438-6444. doi: 10.1007/s00464-023-10124-8. Epub 2023 May 18.
The American Board of Surgery made the Fundamentals of Laparoscopic Surgery (FLS) exam a prerequisite for board certification in 2009. Some residency programs have questioned the need for a continued FLS testing mandate given limited evidence that supports the impact of FLS on intraoperative skills. The Society for Improving Medical Professional Learning (SIMPL) app is a tool to evaluate resident intraoperative performance. We hypothesized that general surgery resident operative performance would improve immediately after preparing for the FLS exam.
The national public FLS data registry was matched with SIMPL resident evaluations from 2015 to 2021 and de-identified. SIMPL evaluations are scored in three categories: supervision required (Zwisch scale 1-4, 1 = show and tell and 4 = supervision only), performance (scale 1-5, 1 = exceptional and 5 = unprepared), and case complexity (scale 1-3, 1 = easiest and 3 = hardest). Statistical analyses compared pre and post-FLS exam resident average operative evaluation scores.
There were a total of 76 general surgery residents, and 573 resident SIMPL evaluations included in this study. Residents required more supervision in laparoscopic cases performed before compared to after the FLS exam (2.84 vs. 3.03, respectively, p = 0.007). Residents performance scores improved from cases before compared to after the FLS exam (2.70 vs. 2.43, respectively, p = 0.001). Case complexity did not differ before versus after the FLS exam (2.13 vs. 2.18, respectively, p = 0.202). PGY level significantly predicted evaluation scores with a moderate correlation. A sub analysis grouped by PGY level revealed a significant improvement after the FLS exam in supervision among PGY-2 residents (2.33 vs. 2.58, respectively, p = 0.04) and performance among PGY-4 residents (2.67 vs 2.04, respectively, p < 0.001).
Preparation for, and passing, the FLS exam improves resident intraoperative laparoscopic performance and independence. We recommend taking the exam in the first two years of residency to enhance the laparoscopic experience for the remainder of training.
美国外科学委员会在 2009 年将腹腔镜手术基础（FLS）考试作为委员会认证的先决条件。一些住院医师项目质疑继续进行 FLS 测试的必要性，因为有限的证据表明 FLS 对外科手术技能有影响。改善医学专业学习协会（SIMPL）应用程序是评估住院医师手术表现的工具。我们假设普通外科住院医师的手术表现会在为 FLS 考试做准备后立即提高。
国家公共 FLS 数据登记与 2015 年至 2021 年 SIMPL 住院医师评估相匹配，并进行了去识别化处理。SIMPL 评估分为三个类别：需要监督（Zwisch 量表 1-4，1=讲解，4=仅监督）、表现（量表 1-5，1=出色，5=准备不足）和手术复杂性（量表 1-3，1=最简单，3=最难）。统计分析比较了 FLS 考试前后住院医师平均手术评估得分。
共有 76 名普通外科住院医师，本研究共纳入 573 名住院医师 SIMPL 评估。与 FLS 考试前相比，住院医师在腹腔镜手术中需要更多的监督（分别为 2.84 和 3.03，p=0.007）。与 FLS 考试前相比，住院医师的表现评分从手术中有所提高（分别为 2.70 和 2.43，p=0.001）。与 FLS 考试前相比，手术复杂性没有差异（分别为 2.13 和 2.18，p=0.202）。住院医师水平与评估得分呈显著相关，呈中度相关。按住院医师水平进行的亚分析显示，PGY-2 住院医师在 FLS 考试后的监督（分别为 2.33 和 2.58，p=0.04）和 PGY-4 住院医师的表现（分别为 2.67 和 2.04，p<0.001）有显著提高。
为 FLS 考试做准备并通过考试可以提高住院医师手术中的腹腔镜技能和独立性。我们建议在住院医师培训的前两年参加考试，以增强其余培训期间的腹腔镜经验。
