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Applicability of the Fundamentals of Laparoscopic Surgery Exam to OBGYN Practice
Purpose: In the climate of increasing specialization and
advancing laparoscopic techniques, the goal of this study is to determine if
the 5 required tasks in FLS exam are relevant skills for gynecologists. We
hypothesize that the FLS exam does not correlate with current practice of
gynecologic surgery and suggest that there may be better tasks to assess
competency for graduating OBGYN residents.
Background: In an effort to standardize surgical knowledge and
skills, the FLS exam is now being required to be a board certified OBGYN.
While this test has been validated and used for many years in general surgery
training, there have been few studies showing its translation to current OBGYN
training. The test has a written portion and a manual exam comprising of a peg
transfer, cutting, intracorporal, extracorporeal suture tying and endoloop.
Methods: This is a cross sectional study, in which OBGYN
attendings, including generalists and sub specialists at a community
hospital. In the initial portion of the study, participants were surveyed
on their laparoscopic case volume, confidence in laparoscopic surgery, prior
training years experience, perception on applicability of the manual FLS tasks
to their practice. In the second portion of the study, the participants
will be assessed by two evaluators in the five FLS tasks. Times, penalties and
overall pass rates will be measured. A post test survey will be administered
regarding the applicability of the FLS tasks in their practice.
Results: Preliminary data with a sample size of 17 from
pre-test survey showed that the vast majority of practicing OBGYNs rarely or
never used an endoloop, intracorporeal and extracorporeal knots. There
were no correlations found between surgeon characteristics and beliefs on FLS
exam. The practical skills evaluation is currently ongoing.
Discussions: There are several weaknesses to this study, including
self reporting bias, lack of awareness of the components FLS exam, small sample
size, and limitation to one institution. The next steps of this study
will be to increase sample size and other include institutions OBGYN attendings
and begin evaluating practicing OBGYNs on the 5 FLS tasks. This
study also does not address the written portion of the FLS exam.
CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Medical Knowledge, Practice-Based Learning & Improvement, GME, Assessment, Minimally Invasive Surgery, General Ob-Gyn,