title: Evaluation of advanced laparoscopic skills tasks for validity evidence.
abstract: BACKGROUND
  Since fundamentals of laparoscopic surgery (FLS) represents a minimum proficiency standard for laparoscopic surgery, more advanced proficiency standards are required to address the needs of current surgical training. We wanted to evaluate the acceptance and discriminative ability of a novel set of skills building on the FLS model that could represent a more advanced proficiency standard-advanced laparoscopic surgery (ALS).
  
  
  METHODS
  Qualitative and quantitative analyses were employed. Quantitative analysis involved comparison of expert (PGY 5+), intermediate (PGY 3-4) and novice (PGY 1-2) surgeons on FLS and ALS tasks. Composite scores included time and errors. Standard FLS errors were added to task time to create the composite score. Qualitative analysis involved thematic review of open-ended questions provided to experts participating in the study.
  
  
  RESULTS
  Out of 48 participants, there were 15 (31 %) attendings, 3 (6 %) fellows and 30 (63 %) residents. By specialty, 54 % were general/MIS/bariatric/colorectal (GMBC) and 46 % were other (urology and gynecology). There was no difference between experience level and performance on FLS and ALS tasks for the entire cohort. However, looking at the GMBC subgroup, experts performed better than novices (p = 0.012) and intermediates performed better than novices (p = 0.057) on ALS tasks. There was no difference for the same group in FLS performance. Also, GMBC subgroup performed significantly better on FLS (p = 0.0035) and ALS (p = 0.0027) than the other subgroup. Thematic analysis revealed that the majority of experts felt that ALS was more realistic, challenging and clinically relevant for specific situations compared to FLS.
  
  
  CONCLUSIONS
  For GMBC surgeons, we were able to show evidence of validity for a series of advanced laparoscopic tasks and their relationship to surgeon skill level. This study may represent the first step in the development of an advanced laparoscopic skills curriculum. Given the high degree of specialization in surgery, different advanced skills curricula will need to be developed for each specialty.
authors.affiliation: Department of General Surgery, Lahey Hospital and Medical Center, Burlington, MA, 01805, USA, dmitry.nepomnayshy@lahey.org.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Nepomnayshy
authors.forename: James
authors.initials: J
authors.lastname: Whitledge
authors.forename: Richard
authors.initials: R
authors.lastname: Birkett
authors.forename: Theodore
authors.initials: T
authors.lastname: Delmonico
authors.forename: Robin
authors.initials: R
authors.lastname: Ruthazer
authors.forename: Lelan
authors.initials: L
authors.lastname: Sillin
authors.forename: Neal E
authors.initials: NE
authors.lastname: Seymour
mesh_terms: D050110:Bariatric Surgery / Q000592:standards; D002983:Clinical Competence / Q000592:standards*; D003479:Curriculum; D019317:Evidence-Based Medicine; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000592:standards; D006801:Humans; D010535:Laparoscopy / Q000592:standards*; D008297:Male; D013536:Suture Techniques; D013647:Task Performance and Analysis; D013520:Urologic Surgical Procedures / Q000592:standards