Association of Fundamentals of Laparoscopic Surgery Certification With Outcomes of Laparoscopic Cholecystectomy Performed by Surgical Residents

Dubina, Emily D.; Pham, Xuan-Binh D.; Schwed, Alexander C.; Wu, Hoover; McElroy, Imani; Kaji, Amy H.; Virgilio, Christian de

doi:10.1001/jamasurg.2018.2705

“…Fundamentals of Laparoscopic Surgery (FLS) testing has never claimed to decrease surgical complications; rather, FLS testing is a verification of the knowledge and skills required to perform basic laparoscopy. Practicing FLS skills to proficiency may help to accelerate learning and clinical transfer of skills, but there are no data about this in the current study . In addition, as noted in their communication citing the work of Schwaitzberg et al on 53 632 laparoscopic cholecystectomies, where FLS graduates performed statistically worse in terms of bile duct injury, some key points were missed.…”

mentioning

confidence: 69%

“…In the study by Dubina et al, we would not expect differences in complications with FLS certification unless inadequate supervision was involved. In addition, the percentage of the procedure the resident performed and the resident operative performance were not reported.…”

mentioning

confidence: 92%

“…Dubina et al seem to imply that there are concerns with the validity of the FLS test, but they do not themselves conduct a validity examination, and there is nothing in their data other than opinion to support this conclusion. The Society of American Gastrointestinal and Endoscopic Surgeons regularly reevaluates the content of the cognitive and skills portions of the FLS curriculum and the relevance and accuracy of the test blueprint.…”

mentioning

confidence: 99%

“…To the Editor The Research Letter by Dubina et al misses the mark with the stated conclusion. Fundamentals of Laparoscopic Surgery (FLS) testing has never claimed to decrease surgical complications; rather, FLS testing is a verification of the knowledge and skills required to perform basic laparoscopy.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Debunking Myths About the Purpose and Intentions of Fundamentals of Laparoscopic Surgery Testing

Vassiliou

¹

,

Mellinger

²

,

Schwaitzberg

³

2019

JAMA Surg

0

View full text Add to dashboard Cite

To the Editor The Research Letter by Dubina et al 1 misses the mark with the stated conclusion. Fundamentals of Laparoscopic Surgery (FLS) testing has never claimed to decrease surgical complications; rather, FLS testing is a verification of the knowledge and skills required to perform basic laparoscopy. Practicing FLS skills to proficiency may help to accelerate learning and clinical transfer of skills, but there are no data about this in the current study. 1 In addition, as noted in their communication citing the work of Schwaitzberg et al 2 on 53 632 laparoscopic cholecystectomies, where FLS graduates performed statistically worse in terms of bile duct injury, some key points were missed. First, the FLS examination does not assess any knowledge or skills specific to cholecystectomy and thus is not expected to affect bile duct injury. The key finding of the study by Schwaitzberg et al 2 was demonstration of an experience and perception gap between recent graduates and more experienced surgeons. Out of that work, the Society of American Gastrointestinal and Endoscopic Surgeons Safe Cholecystectomy task force was created. Second, the analysis of complications specifically addressed in the FLS curriculum demonstrated a leveling-out of outcomes between junior and senior surgeons, suggesting it was possible to narrow the experience gap through education, training, and assessment. Finally, delineating the statistical effect on bile duct injury specifically (despite a 50% reduction in the FLS group) in a sample of only 3000 patients is potentially misleading when interpreting the results as having no difference.In the study by Dubina et al, 1 we would not expect differences in complications with FLS certification unless inadequate supervision was involved. In addition, the percentage of the procedure the resident performed and the resident operative performance were not reported. The lack of such information makes it extrapolative at best to determine what role if any FLS training (which is not synonymous with FLS certification) may have had on outcomes.All physicians, not just residents, have time constraints and must set and apply priorities in their learning strategies. Accordingly, the issue of a mandate as a motivation for residents to study, practice, and pass the examination may be significant. The American Board of Surgery and the American Board of Obstetrics and Gynecology have recognized the value of standardized curricula and skills assessments for minimally qualified candidates. We agree that additional welldone assessments of the translation of basic training to the clinical performance arena would be of value. 3

show abstract

“…An unintended consequence of FLS certification may be that trainees rely only on "passing" the FLS examination as a determination of competency and do not continue to improve their skills [25]. Indeed, in the general surgery literature, a few recent studies have shown that cholecystectomy complications increased over time after FLS certification [25,26]. This type of evidence is especially pertinent in assessments with a high-stakes end point such as board eligibility because it aims to show that a trainee who has passed an assessment (and is board eligible) will be a safe surgeon.…”

Section: Discussionmentioning

confidence: 99%

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

Lerner

¹

,

DeStephano

²

,

Ulrich

³

et al. 2021

Journal of Minimally Invasive Gynecology

View full text Add to dashboard Cite

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.

show abstract

Debunking Myths About the Purpose and Intentions of Fundamentals of Laparoscopic Surgery Testing—Reply

Dubina

¹

,

Pham

²

,

Virgilio

³

2019

JAMA Surg

Self Cite

1

0

View full text Add to dashboard Cite

To the Editor The Research Letter by Dubina et al 1 misses the mark with the stated conclusion. Fundamentals of Laparoscopic Surgery (FLS) testing has never claimed to decrease surgical complications; rather, FLS testing is a verification of the knowledge and skills required to perform basic laparoscopy. Practicing FLS skills to proficiency may help to accelerate learning and clinical transfer of skills, but there are no data about this in the current study. 1 In addition, as noted in their communication citing the work of Schwaitzberg et al 2 on 53 632 laparoscopic cholecystectomies, where FLS graduates performed statistically worse in terms of bile duct injury, some key points were missed. First, the FLS examination does not assess any knowledge or skills specific to cholecystectomy and thus is not expected to affect bile duct injury. The key finding of the study by Schwaitzberg et al 2 was demonstration of an experience and perception gap between recent graduates and more experienced surgeons. Out of that work, the Society of American Gastrointestinal and Endoscopic Surgeons Safe Cholecystectomy task force was created. Second, the analysis of complications specifically addressed in the FLS curriculum demonstrated a leveling-out of outcomes between junior and senior surgeons, suggesting it was possible to narrow the experience gap through education, training, and assessment. Finally, delineating the statistical effect on bile duct injury specifically (despite a 50% reduction in the FLS group) in a sample of only 3000 patients is potentially misleading when interpreting the results as having no difference.In the study by Dubina et al, 1 we would not expect differences in complications with FLS certification unless inadequate supervision was involved. In addition, the percentage of the procedure the resident performed and the resident operative performance were not reported. The lack of such information makes it extrapolative at best to determine what role if any FLS training (which is not synonymous with FLS certification) may have had on outcomes.All physicians, not just residents, have time constraints and must set and apply priorities in their learning strategies. Accordingly, the issue of a mandate as a motivation for residents to study, practice, and pass the examination may be significant. The American Board of Surgery and the American Board of Obstetrics and Gynecology have recognized the value of standardized curricula and skills assessments for minimally qualified candidates. We agree that additional welldone assessments of the translation of basic training to the clinical performance arena would be of value. 3

show abstract

Association of Fundamentals of Laparoscopic Surgery Certification With Outcomes of Laparoscopic Cholecystectomy Performed by Surgical Residents

Cited by 5 publications

References 5 publications

Debunking Myths About the Purpose and Intentions of Fundamentals of Laparoscopic Surgery Testing

Debunking Myths About the Purpose and Intentions of Fundamentals of Laparoscopic Surgery Testing

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

Debunking Myths About the Purpose and Intentions of Fundamentals of Laparoscopic Surgery Testing—Reply

Contact Info

Product

Resources

About