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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.  

Topics: CREOG & APGO Annual Meeting, 2020, Resident, Faculty, Residency Director, Medical Knowledge, Practice-Based Learning & Improvement, GME, Assessment, Minimally Invasive Surgery, General Ob-Gyn,

General Information

Resident,Faculty,Residency Director,
Medical Knowledge,Practice-Based Learning & Improvement,
Clinical Focus
Minimally Invasive Surgery,General Ob-Gyn,

Author Information

Jessica Li, MD, Stamford Hospital; Sarah Kim, MD

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