APGO

Kelli M. Braun, MD
Georgia Regents University, Augusta, Ga

Study Objective: The Fundamentals of Laparoscopic Surgery (FLS) is a non-specialty specific validated curriculum to teach basic laparoscopic skills and knowledge. Extensively tested in general surgery, graduating surgical residents are now required to pass the FLS examination for board certification. Our goal was to test the transferability of the FLS curriculum to Ob-Gyn residents at all stages of training and to evaluate the resources required for implementation and maintenance of the program.

Methods: The FLS program was approved by the education committee and adopted as a replacement curriculum for our single institution academic center in August 2012-April 2013; it consists of four online cognitive modules and five technical skills (peg transfer, pattern cut, ligating loop, intracorporeal knot and extracorporeal knot) which are proficiency based for time and accuracy. Residents completed the online modules at their own pace and were instructed on the skills tasks, per FLS Protocol, during monthly scheduled proctored sessions with Ob-Gyn faculty. Residents practiced each skill until proficiency was achieved and recorded each task repetition on the FLS data sheet. Pre-and post-curriculum testing was conducted for the technical skills and post-testing only was completed for the cognitive modules using provided online 49 question exam. Tasks were scored per FLS protocol with a normalized score of 500 indicating superior performance. All costs and materials related to the program were collected.

Results: All residents participated in the technical skills and practiced until proficiency was reached, while only 27% completed the online modules. Pre-test scores of 138 ± 73 increased 228% following manual training to 453 ± 29, (p<0.001), with all residents, regardless of year of training, attaining manual skills scores equivalent to FLS certification (>270) at post-test (vs. one resident at pre-test). Mean number of task repetitions to obtain proficiency were comparable to published means (118 total repetitions for all tasks vs 119). Mean score on the cognitive exam was 82.7%. We allotted 8 months for the curriculum given sample size. The initial investment for implementation was $10,389 (purchase of trainers, video monitors, ligating loops, and online access for 15 residents), and subsequent yearly maintenance of the program was $918.

Conclusions: The results of this study suggest that the FLS Program holds promise as a curriculum to teach basic laparoscopic skills and knowledge in Ob-Gyn residents. Based on the pilot data, our program has elected to continue it on a yearly basis. Although initial investment can be high, yearly maintenance is much less expensive and for those programs with a simulation infrastructure, initial implementation would be similar to yearly maintenance.

Key Words: Surgical skills, laparoscopy