Malpractice carrier underwrites Fundamentals of Laparoscopic Surgery training and testing: a benchmark for patient safety.
BACKGROUND
Fundamentals of Laparoscopic Surgery (FLS) is a validated program developed by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) to educate and assess competency in minimally invasive surgery (MIS). This study reports the first malpractice carrier-sponsored FLS course for surgeons in practice underwritten by the Controlled Risk Insurance Company of Harvard's Risk Management Foundation (CRICO/RMF). The study investigated the participating surgeons' pattern of MIS skills acquisition, subjective laparoscopic comfort level, operative activity, and perception of the FLS role in surgical education, credentialing, and patient safety.


METHODS
A 1-day postgraduate continuous medical education (CME) course consisted of didactic presentations of the leading MIS faculty, proctored FLS hands-on training, psychomotor testing, and cognitive computer-based examination. Voluntary anonymous pre- and postcourse surveys were distributed to the participants at registration and at completion of both the didactic teaching and the skills modules of the program.


RESULTS
The course was attended by 37 practicing surgeons in the Harvard system, and 86% of the survey forms were returned. The major driving forces for attending the course were directive from the chief/chairman (50%), improvement in MIS didactic knowledge (56%), and the belief that FLS would become a standard such as advanced trauma life support (ATLS), advanced cardiac life support (ACLS), or the like (53%). Surgeons reported that the FLS exam content was appropriate (Likert 4.41 +/- 0.91) and that mastery of the course material would improve safety (Likert 4.13 +/- 0.79) and technical knowledge of MIS (Likert 4.03 +/- 1.00).


CONCLUSIONS
This unique cooperative effort between a liability carrier, a professional surgical society, and proactive surgeons should be considered a model for advancing competency and patient safety. The survey results indicate a positive view of FLS in surgical training, safety, and MIS education.
Derevianko
Alexandre Y
AY
Section of Minimally Invasive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA. aderevia@bidmc.harvard.edu
Schwaitzberg
Steven D
SD
Tsuda
Shawn
S
Barrios
Limaris
L
Brooks
David C
DC
Callery
Mark P
MP
Fobert
David
D
Irias
Noel
N
Rattner
David W
DW
Jones
Daniel B
DB
D002983:Clinical Competence; D003162:Competency-Based Education; D003479:Curriculum; D004502:Education, Medical, Continuing; D004503:Education, Medical, Graduate; D004521:Educational Measurement; D006801:Humans; D007343:Insurance Carriers / Q000191:economics; D007351:Insurance, Liability / Q000191:economics; D010535:Laparoscopy / Q000592:standards*; D008318:Malpractice / Q000191:economics; D012308:Risk Management; D011795:Surveys and Questionnaires
Surg Endosc. 2008 Apr;22(4):885-900
18071813
J Am Coll Surg. 2004 Jan;198(1):105-10
14698317
Surgery. 2004 Jan;135(1):21-7
14694297
Gastrointest Endosc Clin N Am. 2006 Jul;16(3):425-34
16876715
Surg Endosc. 2005 Dec;19(12):1572-8
16235127
Surg Endosc. 2007 Nov;21(11):1991-5
17593434
Curr Probl Surg. 2009 Apr;46(4):271-370
19249439
J Gastrointest Surg. 2008 Feb;12(2):210-2
17955315
J Am Coll Surg. 2005 Jul;201(1):23-9
15978440
Surg Endosc. 1999 Nov;13(11):1077-81; discussion 1082
10556441
Surg Endosc. 2000 Feb;14(2):149-53
10656949
J Minim Invasive Gynecol. 2007 May-Jun;14(3):379-88
17478376
Surgery. 2007 Jun;141(6):831-2
17560266
Surg Innov. 2007 Jun;14(2):107-12
17558016
Surg Endosc. 2005 Sep;19(9):1211-5
16132320
Ann Surg. 2007 Nov;246(5):705-11
17968158
Surg Endosc. 2003 Jun;17(6):964-7
12658417
Surgery. 2005 Aug;138(2):165-70
16153423
J Clin Anesth. 1995 Dec;7(8):675-87
8747567
Surg Innov. 2005 Dec;12(4):345-8
16424956
Can J Surg. 1999 Aug;42(4):293-6
10459330
J Endourol. 2005 Jun;19(5):541-5
15989441
J Am Coll Surg. 2006 Apr;202(4):599-603
16571429
Am J Surg. 2006 Jan;191(1):23-7
16399101
Surg Endosc. 1998 Sep;12(9):1117-20
9716763
Med Educ. 2004 Jan;38(1):45-55
14962026
J Can Dent Assoc. 1999 Jul-Aug;65(7):384-6
10465917
Surg Endosc. 2008 Aug;22(8):1887-93
18270774
Surgery. 2006 Aug;140(2):252-62
16904977
Surg Innov. 2008 Mar;15(1):69-73
18387999
J Am Coll Surg. 2007 Aug;205(2):307-13
17660078
Am J Surg. 2007 Apr;193(4):502-6
17368299
Surg Endosc. 2004 May;18(5):779-81
15026928
Br J Surg. 1997 Feb;84(2):273-8
9052454
J Med Pract Manage. 2006 Jul-Aug;22(1):50-1
16986643
Surg Endosc. 2008 Jan;22(1):196-201
17705087
Am J Surg. 1998 Jun;175(6):482-7
9645777
Surgery. 2004 Jan;135(1):28-42
14694298
J Gastrointest Surg. 2008 Feb;12(2):222-33
18004630
J Health Adm Educ. 2007 Winter;24(1):43-57
17847866
Surg Endosc. 2006 May;20(5):744-7
16508817
Ann Surg. 2004 Sep;240(3):518-25; discussion 525-8
15319723
Stud Health Technol Inform. 2007;125:149-54
17377255
Arch Intern Med. 2007 Oct 22;167(19):2030-6
17954795
Surg Endosc. 2007 Mar;21(3):357-66
17180270
J Am Coll Surg. 2006 Jan;202(1):62-9
16377498
Surg Endosc. 2007 Aug;21(8):1441-5
17593461