A Systematic Review of Validity Evidence for the Fundamentals of Laparoscopic Surgery Examination in Gynecology

Abstract

Objective: The Fundamentals in Laparoscopic Surgery (FLS) examination is designed to test laparoscopic surgery skills. Our aim for this systematic review was to examine validity evidence supporting or refuting the FLS examination specifically as a high-stakes summative assessment tool in gynecology. Data Sources: The data sources were PubMed, MEDLINE, Embase, and Scopus. Methods of Study Selection: The study eligibility criterion was the subject of the FLS examination as an assessment tool in gynecology. We developed a data extraction tool and assigned articles for screening and extraction to all authors, who then abstracted data independently. Conflicts that arose during the extraction process were resolved by consensus. We organized validity evidence for the cognitive and manual skills portions on the basis of the categories of current validation standards. Tabulation, Integration, and Results: From 1971 citations identified, 9 studies were included, involving 319 participants. For the cognitive portion of the test, the results were mixed in 5 studies in relationships with the other variables category. For the manual portion of the test, most of the studies focused on the relationships with other variables evidence with mixed findings. The concerning findings in the manual skills portion included the lack of transferability of skills to the operating room, limited mixed evidence for improvement in operating room performance, and worse performance by obstetrics and gynecology surgeons compared with other specialties. We did not find supportive content-based, response process, or consequential evidence in either the cognitive or manual skills portion of the test. Conclusion:Validity evidence for the FLS examination was either mixed, as it pertained to relationships with other variables, or lacking in other important evidence categories. Further evidence is required to justify the use of the FLS examination scores as a high-stakes summative assessment.

Evaluation of different approaches to define expert benchmark scores for new robotic training simulators based on the Medtronic HUGO™ RAS surgical robot experience

“…We know, for example, that in the Fundamentals of Laparoscopic Surgery (FLS) the passing rate was set at 10 times in total. 14,15 It is anticipated that these default benchmarks will initially be used "as is" by institutions, until further studies suggest updates are necessary. However, current simulation software does allow Institutions to modify these benchmarks as well as the pro ciency criteria, such as number of required passes.…”

Hands-on Simulation Workshop for Obstetric Ultrasound-Guided Invasive Procedures

“…To address this gap in training, we sought to create an easy-to-set-up simulator that would allow learners to practice specific parts of a procedure and hold their attention for extended periods of time. Our original concept was an analogue of the Fundamentals of Laparoscopic Surgery 15 , 16 or a set of nonclinical tasks that would allow one to practice the psychomotor skills used during ultrasound-guided invasive procedures. We named this training system the Fundamentals of Ultrasound Needle Guided Interventions, or FUNGI for short.…”

Development and validation of GLVS (Generic Laparoscopic Video Scoring System), a tool for assessment of laparoscopic skills in gynaecology using videotaped procedures: Are edited videos representative of their full-length version?

“…Fundamentals in Laparoscopic surgery (FLS) has been widely used to test laparoscopic surgical skills and is a prerequisite for board eligibility in general surgery and obstetrics and gynaecology (American Board of Obstetrics and Gynecology). A recent systematic review examining the validity evidence of FLS examination has shown to be mixed or lacking (Lerner et al, 2021). Another example is the Objective Structured Clinical Examination (OSCE) and Objective Structured Assessment of Technical Skills (OSATs) which have been in use for some time now (Faulkner et al, 1996;Martin et al, 1997;Regehr et al, 1998).…”