title: Validity evidence for the Fundamentals of Laparoscopic Surgery (FLS) program as an assessment tool: a systematic review.
abstract: BACKGROUND
  The Fundamentals of Laparoscopic Surgery (FLS) program uses five simulation stations (peg transfer, precision cutting, loop ligation, and suturing with extracorporeal and intracorporeal knot tying) to teach and assess laparoscopic surgery skills. We sought to summarize evidence regarding the validity of scores from the FLS assessment.
  
  
  METHODS
  We systematically searched for studies evaluating the FLS as an assessment tool (last search update February 26, 2013). We classified validity evidence using the currently standard validity framework (content, response process, internal structure, relations with other variables, and consequences).
  
  
  RESULTS
  From a pool of 11,628 studies, we identified 23 studies reporting validity evidence for FLS scores. Studies involved residents (n = 19), practicing physicians (n = 17), and medical students (n = 8), in specialties of general (n = 17), gynecologic (n = 4), urologic (n = 1), and veterinary (n = 1) surgery. Evidence was most common in the form of relations with other variables (n = 22, most often expert-novice differences). Only three studies reported internal structure evidence (inter-rater or inter-station reliability), two studies reported content evidence (i.e., derivation of assessment elements), and three studies reported consequences evidence (definition of pass/fail thresholds). Evidence nearly always supported the validity of FLS total scores. However, the loop ligation task lacks discriminatory ability.
  
  
  CONCLUSIONS
  Validity evidence confirms expected relations with other variables and acceptable inter-rater reliability, but other validity evidence is sparse. Given the high-stakes use of this assessment (required for board eligibility), we suggest that more validity evidence is required, especially to support its content (selection of tasks and scoring rubric) and the consequences (favorable and unfavorable impact) of assessment.
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Mayo 12-W, 200 First Street SW, Rochester, MN, 55905, USA. zendejas.benjamin@mayo.edu.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Zendejas
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Mayo 12-W, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Raaj K
authors.initials: RK
authors.lastname: Ruparel
authors.affiliation: Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.|Multidisciplinary Simulation Center, Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Cook
mesh_terms: D002983:Clinical Competence; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D015203:Reproducibility of Results; D000066908:Simulation Training / Q000379:methods*; D014481:United States
keywords: Assessment; Fundamentals of Laparoscopic Surgery; Simulation; Validation