title: What is the cost associated with the implementation of the FLS program into a general surgery residency?
abstract: BACKGROUND
  The implementation cost of the Fundamentals of Laparoscopic Surgery (FLS) program is unknown. The objective of this study was to evaluate the cost associated with the implementation of the FLS program into the skills curriculum of a busy general surgery residency.
  
  
  METHODS
  All general surgery residents (n = 15) followed a proficiency-based laparoscopic skills curriculum based on the FLS program. They watched the FLS CD-ROM and trained to proficiency on the five FLS tasks (peg transfer, pattern cut, ligating loop, and extracorporeal and intracorporeal knot tying). Training occurred in weekly 1-h supervised sessions. The cost associated with the implementation of the FLS program was assessed based on supplies, equipment, and personnel involvement. To decrease cost, task 3 (ligating loop) was modified to allow multiple uses of each endoloop, and sutures and Penrose drains were reused for task 4 (extracorporeal) and task 5 (intracorporeal).
  
  
  RESULTS
  Resident skills lab attendance averaged 51% (range = 16-84%) and totaled 211 h. Fifty-three percent (8/15) of residents achieved proficiency in at least three of the tasks (peg transfer, pattern cut, and ligating loop) after a total of 577 repetitions during the study period. The overall cost associated with the FLS program was $13,091 (personnel cost, $3,338; equipment cost, $8,567; and supplies cost $1,186). The modification of task 3 (each endoloop was used an average of 8.8 times) and the reuse of sutures and Penrose drains saved $3,446.
  
  
  CONCLUSIONS
  This is the first study to describe the cost associated with the implementation of the FLS program in a surgical residency. It demonstrates cost savings by the modification of task 3 (to allow for multiple uses of each endoloop) and tasks 4 and 5 (reuse of suture and Penrose drains) without compromising task quality. This information may be useful to programs implementing FLS into their curricula.
authors.affiliation: Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, NC 28203, USA.
authors.forename: Phuong H
authors.initials: PH
authors.lastname: Nguyen
authors.forename: Christina E
authors.initials: CE
authors.lastname: Acker
authors.forename: B Todd
authors.initials: BT
authors.lastname: Heniford
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Stefanidis
mesh_terms: D003365:Costs and Cost Analysis; D003479:Curriculum; D013502:General Surgery / Q000191:economics* / Q000193:education*; D007396:Internship and Residency / Q000191:economics*; D010535:Laparoscopy / Q000193:education*