title: Feasibility of remote administration of the Fundamentals of Laparoscopic Surgery (FLS) skills test.
abstract: BACKGROUND
  Fundamentals of Laparoscopic Surgery (FLS) certification testing currently is offered at accredited test centers or at select surgical conferences. Maintaining these test centers requires considerable investment in human and financial resources. Additionally, it can be challenging for individuals outside North America to become FLS certified. The objective of this pilot study was to assess the feasibility of remotely administering and scoring the FLS examination using live videoconferencing compared with standard onsite testing.
  
  
  METHODS
  This parallel mixed-methods study used both FLS scoring data and participant feedback to determine the barriers to feasibility of remote proctoring for the FLS examination. Participants were tested at two accredited FLS testing centers. An official FLS proctor administered and scored the FLS exam remotely while another onsite proctor provided a live score of participants' performance. Participant feedback was collected during testing. Interrater reliabilities of onsite and remote FLS scoring data were compared using intraclass correlation coefficients (ICCs). Participant feedback was analyzed using modified grounded theory to identify themes for barriers to feasibility.
  
  
  RESULTS
  The scores of the remote and onsite proctors showed excellent interrater reliability in the total FLS (ICC 0.995, CI [0.985-0.998]). Several barriers led to critical errors in remote scoring, but most were accompanied by a solution incorporated into the study protocol. The most common barrier was the chain of custody for exam accessories.
  
  
  CONCLUSIONS
  The results of this pilot study suggest that remote administration of the FLS has the potential to decrease costs without altering test-taker scores or exam validity. Further research is required to validate protocols for remote and onsite proctors and to direct execution of these protocols in a controlled environment identical to current FLS test administration.
authors.affiliation: Temerty/Chang Telesimulation Centre, Toronto Western Hospital, University Health Network, Toronto, ON, M5T2S8, Canada, allan.okrainec@uhn.ca.
authors.forename: Allan
authors.initials: A
authors.lastname: Okrainec
authors.forename: Melina
authors.initials: M
authors.lastname: Vassiliou
authors.forename: Andrew
authors.initials: A
authors.lastname: Kapoor
authors.forename: Kristen
authors.initials: K
authors.lastname: Pitzul
authors.forename: Oscar
authors.initials: O
authors.lastname: Henao
authors.forename: Pepa
authors.initials: P
authors.lastname: Kaneva
authors.forename: Timothy
authors.initials: T
authors.lastname: Jackson
authors.forename: E Matt
authors.initials: EM
authors.lastname: Ritter
mesh_terms: D000328:Adult; D002568:Certification; D002983:Clinical Competence; D003194:Computer-Assisted Instruction / Q000379:methods*; D004521:Educational Measurement / Q000379:methods*; D005240:Feasibility Studies; D005246:Feedback; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D008297:Male; D010865:Pilot Projects; D019114:Remote Consultation / Q000379:methods*; D015203:Reproducibility of Results
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