title: FLS simulator performance predicts intraoperative laparoscopic skill.
abstract: BACKGROUND
  Simulators are being used more and more for teaching and testing laparoscopic skills. However, it has yet to be firmly established that simulator performance reflects operative laparoscopic skill. The study reported here was designed to test the hypothesis that laparoscopic simulator performance predicts intraoperative laparoscopic skill.
  
  
  METHODS
  A review of our prospectively maintained database identified 40 subjects who underwent Fundamentals of Lapraoscopic Surgery (FLS) skills testing and objective intraoperative assessments within the same 6-month period. Subjects consisted of 22 novice (postgraduate year [PGY] 1-2), 10 intermediate (PGY 3-4), and 8 experienced (PGY 5, fellows, and attendings) laparoscopic surgeons. Laparoscopic performance was objectively assessed in the operating room using the previously validated Global Operative Assessment of Laparoscopic Skill (GOALS). Analysis of variance (ANOVA) was used to compare mean FLS scores and mean GOALS scores across experience levels. The relationship between individual FLS scores and GOALS scores was assessed with linear regression analysis. A multivariate analysis evaluated FLS score and surgeon experience as predictors of intraoperative GOALS score. A receiver-operator curve (ROC) was constructed in order to define an FLS cutoff score that predicts intraoperative performance at or above the level of experienced surgeons. Significance was defined as p < 0.05.
  
  
  RESULTS
  Mean FLS scores and mean GOALS scores increased with increasing experience. Individual FLS scores correlated significantly with intraoperative GOALS scores (0.77, p < 0.001). Multivariate analysis confirmed that FLS score is an independent predictor of intraoperative GOALS scores. The ROC identified an FLS cutoff score of 70 with optimal sensitivity (91%) and specificity (86%) for predicting a GOALS score at or above the level of experienced surgeons.
  
  
  CONCLUSIONS
  In this study sample, FLS simulator scores were independently predictive of intraoperative laparoscopic performance as measured by GOALS. More precisely, an FLS cutoff score of 70 optimized sensitivity and specificity for expert intraoperative performance. A larger prospective study is justified to validate these findings.
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, 1650 Cedar Avenue, #L9.309, Montreal, Quebec, H3G 1A4, Canada.
authors.forename: A L
authors.initials: AL
authors.lastname: McCluney
authors.forename: M C
authors.initials: MC
authors.lastname: Vassiliou
authors.forename: P A
authors.initials: PA
authors.lastname: Kaneva
authors.forename: J
authors.initials: J
authors.lastname: Cao
authors.forename: D D
authors.initials: DD
authors.lastname: Stanbridge
authors.forename: L S
authors.initials: LS
authors.lastname: Feldman
authors.forename: G M
authors.initials: GM
authors.lastname: Fried
mesh_terms: D002983:Clinical Competence; D004502:Education, Medical, Continuing / Q000379:methods*; D004521:Educational Measurement / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D013647:Task Performance and Analysis; D014584:User-Computer Interface