Department of Surgery, University of Massachusetts Chan Medical School-Baystate Health, 759 Chestnut Street, Springfield, MA, 01199, USA.
Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA.
Surg Endosc. 2023 Oct;37(10):7676-7685. doi: 10.1007/s00464-023-10238-z. Epub 2023 Jul 30.
The Fundamentals of Laparoscopic Surgery (FLS) program tests basic knowledge and skills required to perform laparoscopic surgery. Educational experiences in laparoscopic training and development of associated competencies have evolved since FLS inception, making it important to review the definition of fundamental laparoscopic skills. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) assigned an FLS Technical Skills Working Group to characterize technical skills used in basic laparoscopic surgery in current practice contexts and their possible application to future FLS tests.
A group of subject matter experts defined an inventory of 65 laparoscopic skills using a Nominal Group Technique. From these, a survey was developed rating these items for importance, frequency of use, and priority for testing for FLS certification. This survey was distributed to SAGES members, recent recipients of FLS certification, and members of the Association of Program Directors in Surgery (APDS). Results were collected using a secure web-based survey platform.
Complete data were available for 1742 surveys. Of these, 1143 comprised results for post-residency participants who performed advanced procedures. Seventeen competencies were identified for FLS testing prioritization by determining the proportion of respondents who identified them of highest priority, at median (50th percentile) of the maximum survey scale rating. These included basic peritoneal access, laparoscope and instrument use, tissue manipulation, and specific problem management skills. Sixteen could be used to show appropriateness of the domain construct by confirmatory factor analysis. Of these 8 could be characterized as manipulative tasks. Of these 5 mapped to current FLS tasks.
This survey-identified competencies, some of which are currently assessed in FLS, with a high level of priority for testing. Further work is needed to determine if this should prompt consideration of changes or additions to the FLS technical skills test component.
腹腔镜手术基础（FLS）课程测试进行腹腔镜手术所需的基本知识和技能。自 FLS 课程设立以来，腹腔镜培训的教育经验和相关能力的发展不断演变，因此，审查基本腹腔镜技能的定义非常重要。美国胃肠内镜外科医师学会（SAGES）指定了一个 FLS 技术技能工作组，以描述当前实践环境中基本腹腔镜手术中使用的技术技能及其可能在未来 FLS 测试中的应用。
一组主题专家使用名义小组技术定义了 65 项腹腔镜技能清单。在此基础上，开发了一项调查，对这些项目进行了重要性、使用频率和 FLS 认证测试优先级的评估。该调查分发给 SAGES 成员、最近获得 FLS 认证的成员以及外科手术项目主任协会（APDS）的成员。使用安全的基于网络的调查平台收集结果。
1742 份调查中提供了完整的数据。其中 1143 份来自接受过高级手术培训的住院医师后阶段参与者的结果。通过确定将这些技能视为最高优先级的受访者比例（最大调查量表评分的中位数[第 50 百分位]），确定了 17 项 FLS 测试优先级的能力。这些能力包括基本腹膜进入、腹腔镜和仪器使用、组织操作以及特定问题管理技能。通过验证性因子分析可以使用 16 项能力来显示域结构的适当性。其中 8 项可被描述为操作任务。其中 5 项映射到当前的 FLS 任务。
这项调查确定了一些能力，其中一些已在 FLS 中进行了评估，并且测试优先级很高。需要进一步研究以确定这是否应该促使考虑对 FLS 技术技能测试部分进行更改或添加。
