title: Beta test results of a new system assessing competence in laparoscopic surgery.
abstract: BACKGROUND
  There is currently a need for objective measures of surgical competence. Such measures should assess knowledge, judgment, and manual skills. The Fundamentals of Laparoscopic Surgery (FLS) program was developed by the Society of American Gastrointestinal and Endoscopic Surgeons to meet these criteria. The FLS assessment includes a multiple-choice cognitive test and a manual skills test. We present the results of validation studies of this novel assessment tool.
  
  
  METHODS
  Beta testing of the FLS examination was undertaken at 7 sites by 70 surgeons representing 4 levels of experience and training. Surgeons provided information about their prior experience and indicated a self-assessment of their laparoscopic competence. Results were assessed by ANOVA followed by orthogonal contrasts.
  
  
  RESULTS
  Cognitive performance by training level: There was no difference between fellows and staff in percentage of questions answered correctly, but there was a discrepancy between junior and senior residents and between residents and senior surgeons (p < 0.01). Cognitive performance by laparoscopic experience quartiles: There were notable contrasts between the first and second quartiles of experience (p < 0.02) and between the third and fourth quartiles (p < 0.01). No marked difference was found between the second and third quartiles. Cognitive performance compared with self-assessment: Test results were substantially different (p < 0.01) between test-takers who assessed themselves as "better than average" and those who assessed themselves as "average" or "below average." Manual skills performance by training level: The major difference was found between junior residents versus senior residents, fellows or staff (p < 0.01). Manual skills performance by laparoscopic experience level: Differences were primarily seen between the first two quartiles and the last two quartiles of laparoscopic experience (p < 0.001). Manual skills performance compared with self-assessment: Those who assessed themselves as "above average" in laparoscopic skill performed markedly better than those indicating they had "average" or "below average" skill (p < 0.01).
  
  
  CONCLUSIONS
  Beta test results for the FLS examination demonstrate satisfactory reliability, appropriate psychometric properties, and substantial initial validity. The FLS project is one of the first validated surgical education efforts to assess the competence of surgeons in a specific field.
authors.affiliation: Department of Minimally Invasive Surgery, Legacy Health System, Portland, OR 97210, USA. lswanstrom@aol.com
authors.forename: Lee L
authors.initials: LL
authors.lastname: Swanstrom
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Fried
authors.forename: Kaaren I
authors.initials: KI
authors.lastname: Hoffman
authors.forename: Nathaniel J
authors.initials: NJ
authors.lastname: Soper
mesh_terms: D001076:Aptitude; D002983:Clinical Competence; D003071:Cognition; D004501:Education, Medical; D006801:Humans; D010535:Laparoscopy; D009048:Motor Skills; D015397:Program Evaluation; D015203:Reproducibility of Results