Fundamentals Of Laparoscopic Surgery Curriculum Research Articles

Modification of Fundamentals of Laparoscopic Surgery Manual Tasks Simulation Curriculum With the Addition of the Vaginal Cuff Closure Training

Fundamentals of Laparoscopic Surgery (FLS) is a multiple-choice test and a manual skills exam using simulation that Obstetrics and Gynecology (OBGYN) residents must pass to qualify for board certification. There is insufficient validity evidence supporting the use of FLS as a high-stakes exam. This study examines the correlation between OBGYN residents' performance on the FLS manual tasks and simulated vaginal cuff closure. We compared residents' performance on FLS tasks with simulated vaginal cuff suturing on a model. During the first coached simulation session, after completion of training on the standard 5 FLS tasks, residents were coached on vaginal cuff closure using a simulated model placed inside the standard FLS box trainer. At a subsequent session, their performance was scored using the Global Operative Assessment of Laparoscopic Skills Scale (GOALS) and a second task-specific metric, and these scores were compared to their official FLS score. Twenty-nine residents completed the vaginal cuff simulation training between June 2019 and November 2021. Nineteen of the 29 were able to complete the cuff closure with the mean time to completion being 14.5 minutes. We found no correlation between official manual skills FLS scores and vaginal cuff GOALS scores (rho = -0.02, p = 0.90) or cuff closure assessment tool score (rho = -0.015, p = 0.048). There was also no correlation between time to completion for any FLS task and vaginal cuff closure OSAT scores. All residents reported that they found the cuff to be a useful addition to the FLS curriculum. Our study demonstrated that trainee performance on a simulated vaginal cuff closure model did not correlate with official FLS manual tasks skills. This finding adds to the body of evidence disputing the use of FLS as a high-stakes exam to assess laparoscopic skills in gynecology in the relationship with other variables category.

8895 Fundamentals of Laparoscopic Surgery for Senior Medical Students Entering Surgical Residency

<h3>Study Objective</h3> The Fundamentals of Laparoscopic Surgery (FLS) is mandatory for OBSTETRICS AND GYNECOLOGY residency. We aimed to evaluate the usefulness of FLS for fourth year medical students to gain confidence and to determine quantitative improvement in FLS tasks and exam. <h3>Design</h3> On the first and last day of the course, students completed a Likert scale (1-10) self-assessment rating confidence in knowledge of laparoscopy, confidence in technical laparoscopic skills, and satisfaction with laparoscopic training during medical school. Students also completed the FLS written assessment. For two weeks, students had didactics and practiced the five practical tasks on FLS trainers: peg transfer, circle cutting, endoloop, extracorporeal and intracorporeal knot tying. Pre and post practice times were recorded. Students were evaluated by OBSTETRICS AND GYNECOLOGY faculty mentors with a pre and post validated global assessment tool per FLS task. <h3>Setting</h3> Fourth year medical school elective in an academic setting. <h3>Patients or Participants</h3> Sixteen fourth year medical students enrolled in the two-week FLS elective course over two years (2021-2022). <h3>Interventions</h3> Participants received daily didactic lessons taught by OBSTETRICS AND GYNECOLOGY faculty, as well as guided practice sessions utilizing laparoscopic task trainers. All interventions were measured pre and post didactic sessions. <h3>Measurements and Main Results</h3> Overall, students felt more confident in their combined laparoscopic knowledge, skills, and training assessment following the course (2.3 (1.7) vs. 6.1 (2.0), p<0.001). Students showed improvement on the written exam (.62 (.10) vs. .87 (.06), p<0.001). The mean time to complete all five of the FLS tasks decreased (seconds, 247 (135) vs. 143 (102), p<0.001). Finally, the average combined faculty global rating assessment of the students' performance improved (2.3 (0.4) vs. 3.9 (0.3), p<0.001). Feedback from students was universally positive. <h3>Conclusion</h3> Implementing the FLS curriculum for fourth year medical students increases confidence in laparoscopic knowledge and performance of technical skills prior to entering a surgical residency.

Effect of the Fundamentals of Laparoscopic Surgery Curriculum on Skills of Operating Room Technology Students: An Interventional Study

Background: In a laparoscopic surgery team, a surgical technologist as a skillful assistant surgeon is responsible for camera navigation and peg transfer. Objectives: We assessed the effect of the fundamentals of laparoscopic surgery curriculum on improving the skills of surgical technology students in camera navigation, pattern cutting, and peg transfer. Methods: A study was conducted on 30 surgical technology students at the Iran University of Medical Sciences based on Kern's six-step model. After assessing the needs and defining the educational goals, the course content was determined. Afterward, students were trained in a simulation-based learning environment. Then, in the evaluation stage, using the standard task completion time (TCT) tool, their competence in performing the three skills was evaluated. The results of the first comprehensive attempt to perform each skill were recorded as the pretest, and the results of the sixth and 10th repetitions were recorded as the posttest. Data were analyzed using analysis of variance with duplicate data. Results: The TCT score improved in this study. The time of camera navigation decreased from 92.14 to 56.42 s, pattern cutting from 186.07 to 118.21 s, and peg transfer from 93.03 to 54.10 s. Conclusions: This study showed that the fundamentals of laparoscopic surgery curriculum improved the surgical technologists’ competence in performing triple skills essential for performing laparoscopic surgeries. Thus, this learning method could play an essential role in laparoscopic surgery.

A Low-Cost Platform for Laparoscopic Simulation Training.

With the new requirement for Fundamentals of Laparoscopic Surgery certification among graduating obstetrics and gynecology residents, there has been an increased interest in simulation training. The Fundamentals of Laparoscopic Surgery curriculum uses a commercial laparoscopic box trainer to practice and assess laparoscopic skills. We created a low-cost, space-efficient, portable and versatile training platform that allows for the breakdown of complex tasks, and we studied its user acceptability. A rectangular piece of pine wood purchased at a hardware store was used as a base; metal eye hooks were used as ports, and a blueprint was created to simulate placement of Fundamentals of Laparoscopic Surgery inserts. In addition to the Fundamentals of Laparoscopic Surgery skills, this platform can be used for any laparoscopic task (such as hysterectomy or cuff closure). Additionally, this platform can be used with or without a camera to allow for task breakdown into simpler components for faster learning. A usability and acceptability survey was administered to a convenient sample of faculty and trainees. Trainees and faculty responded favorably to the model. Residents, fellows, and attendings felt that the laparoscopic platform closely simulated the feel of performing live laparoscopy surgery. This is a novel low-cost laparoscopic platform to add to the gynecologic surgical education simulation toolkit.

Practice Patterns and Learning Curves of Obgyn Residents Preparing for the Fundamentals of Laparoscopic Surgery (FLS) Exam

Study Objective As of 2018, all graduating OBGYN residents are expected to complete and pass a Fundamentals of Laparoscopic Surgery (FLS) exam. Very few studies on FLS implementation in OBGYN residency programs exist. The aim of this study is to describe practice patterns and learning curves of OBGYN residents preparing for the manual skills portion of the FLS exam. Design Prospective cohort study. Setting OBGYN residency program at a large urban academic medical center. Patients or Participants 33 OBGYN residents, post-graduate years one (PGY1) to three (PGY3). Interventions An FLS curriculum, consisting of coached and self-practice sessions. Measurements and Main Results Residents recorded time spent on each training session, as well the type of trainer used and amount of supervision. For every task, residents recorded proficiency metrics, such as time to completion and penalties. Preliminary analysis of four PGY3 residents who took the exam showed that recorded number of repetitions for tasks 1-5 ranged from 1 to 22 and best time without penalties ranged from 30 to 315 seconds. Performance data and learning curves for each task will be presented for every resident. None of the residents met FLS suggested proficiency criteria for all tasks prior to the exam, and all residents passed the manual portion of FLS exam with wide margins (score range 527-673, with 356 as the national passing score). Correlational analyses of performance on each individual task with final exam score, as well as improvement in scores with each repetition, will be calculated when more participants complete training and have final exam scores available. Conclusion Our study compares FLS practice times, modality, and learning curves with final manual exam scores, which will be of great use to OBGYN residencies across the country as they implement FLS curricula into their programs.

Design of a Laparoscopic Curriculum for Obstetrics and Gynecology Residents

PROBLEM: The American Board of Obstetrics and Gynecology (ABOG) announced in January, 2018 it is requiring completion of the Fundamentals of Laparoscopic Surgery (FLS) program as prerequisite for board certification for residents graduating after May, 2020. Currently, our residency program has no formalized laparoscopic curriculum and has never required residents to participate in the FLS program. INTERVENTION: Needs assessment was performed to survey faculty in the residency program regarding residents’ current skill levels and faculty perspectives of level-appropriate laparoscopic skills by training year. A comprehensive laparoscopic curriculum was designed to support resident progression through different competency milestones required to ultimately be able to perform laparoscopic hysterectomies as the surgeon. The laparoscopic curriculum addresses a parallel group of requirements designed to assist residents in successful completion of the FLS curriculum. CONTEXT: The laparoscopic curriculum was designed in the context of an academically-based obstetrics and gynecology residency program. The residency program has 9 residents a year who rotate at 5 different clinical sites and work with over 50 faculty who perform laparoscopic procedures. OUTCOMES/LESSONS LEARNED: The curriculum will be implemented in July 2019 with the new academic year. The curriculum will be assessed in several ways: formal testing of residents with FLS skills by the program administration, time takes resident to progress through the competency milestones for laparoscopy, the FLS pass rate, and scores of our residents. Main lesson learned through the design process was how to manage the varying resident and faculty expectations for surgical skills training.

Laparoscopic Simulation in Reverse and Side Alignment Impact on Forward Alignment Performance: A Randomized Controlled Trial.

The influence of visual-spatial discordance during training on laparoscopic skills is poorly understood. It has been proposed that training in visual-spatial discordant situations can improve performance in the forward alignment, which was the basis of our hypothesis. Our study's aim was to conduct a randomized control trial to explore the impact of simulated training in visual-spatial discordant situations on forward alignment performance. The participants were 80 medical students who were randomized into four groups. Group A served as the control and performed all peg transfers in the forward alignment. Groups B, C, and D experienced varied rounds of either increasing or decreasing sensorimotor discordance. The students were trained and tested using the peg transfer task used in the Fundamentals of Laparoscopic Surgery curriculum. Based on the group, each student performed 10 peg transfer practice rounds in their assigned alignment. After each practice session, each student was tested and scored in forward alignment performance. A baseline test, followed by three practice sessions, and three tests were done. Group A (control) demonstrated a statistically significant overall increase in scoring of 37.1% from baseline when compared to the final test. Groups B, C, and D showed improvements of 3.7%, 27.1%, and 19.3%, respectively, between baseline and the final test, yet none demonstrated consistent linear improvements. On multi-variate analysis, students who practiced in the side or reverse alignment positions scored 25 and 37 points lower, respectively, than students who practiced in the forward alignment. Our study suggests that training in visual-spatial discordant conditions does not lead to the development of forward alignment laparoscopic skills. This could have important implications when developing future laparoscopic skills training curriculums. To our knowledge, this is the largest study to date assessing the impacts of training in visual-spatial discordance situations on performance in the forward alignment.

Affordable Laparoscopic Camera System (ALCS) Designed for Low- and Middle-Income Countries: A Feasibility Study.

Minimally invasive surgical techniques (MISTs) could have tremendous benefits in resource-poor environment. There is growing interest in MISTs in most low- and middle-income countries (LMIC), but its adoption has remained limited; this is largely due to high cost of the initial setup, lack of technological backup and limited access to training among others. An affordable laparoscopic setup will go a long way in improving access to MISTs. A common zero degrees 10mm scope is attached on the camera of a low-price smartphone. Two elastic bands are used to fix the scope right in front of the smartphone's main camera; alternatively, a low-cost camera coupler can be used. The device is covered with sterile transparent drapes and a light source connected with a fiber-optic cable for endoscopic use. The image can be seen in real time on a common TV screen through an HDMI connection to the smartphone, with a sterile drape. We were able to perform the five tasks of the Fundamentals of Laparoscopic Surgery curriculum, using our vision system with proficiency. In a pig model, we performed a tubal ligation to simulate an appendectomy and we were able to suture. No major differences were measured between the two connection systems. A low-cost laparoscopic camera system can benefit surgeons and trainees in LMICs. The system is already attractive for use during training, but further studies are needed to evaluate its potential clinical role in LMICs.

Mandatory completion of a box trainer curriculum prior to laparoscopic apprenticeship in the OR for surgical residents: A Before and After study

IntroductionTraining on laparoscopic box trainer (BT) improves surgical skills in the operating room (OR). Despite a large consensus on the educational value of the BT, its use is currently left up to local initiatives among French residency programs. This study evaluated the impact of a requirement to complete the Fundamentals of Laparoscopic Surgery (FLS) curriculum before starting companionship in the OR. MethodsThis was a “Before and After” study conducted in two French academic hospitals in 2015-2017. Gynaecology and urology residents were given open access to a FLS BT during a six-month surgical rotation. Residents in the first group (Before group) trained on the BT while receiving classic companionship. Residents in the second group (After group) had to complete the FLS curriculum before they were allowed to participate in laparoscopic procedures as a primary operator. Outcomes measures were the time to curriculum completion and the intracorporeal suturing performances based on two validated assessment tools (FLS and GOALS scores). ResultsTwenty-one surgical residents were included. All but two residents in the Before group completed the curriculum. The time to curriculum completion was longer in the Before group than the After group (69.5 days versus 28 days, P=0.001). Post-curriculum performances were lower in the Before group than in the After group for the FLS scores (452.5 versus 496, P=0.01) and the GOALS scores (14.5 versus 18, P=0.01). DiscussionThe mandatory completion of a BT curriculum prior to receiving active companionship in the OR is beneficial to residents in reducing time to curriculum completion and in enhancing laparoscopic skills on the BT.

Trends in laparoscopic colorectal surgery over time from 2005-2014 using the NSQIP database

BackgroundLaparoscopy, originally pioneered by gynecologists, was first adopted by general surgeons in the late 1980s. Since then, laparoscopy has been adopted in the surgical specialties and colorectal surgery for treatment of benign and malignant disease. Formal laparoscopic training became a required component of surgery residency programs as validated by the Fundamentals of Laparoscopic Surgery curriculum; however, some surgeons may be more apprehensive of widespread adoption of minimally invasive techniques. Although an overall increase in the use of laparoscopy in colorectal surgery is anticipated over a 10-year period, it is unknown if a similar increase will be seen in higher risk or more acutely ill patients. MethodsUsing the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database from 2005-2014, colorectal procedures were identified by Current Procedural Terminology codes and categorized to open or laparoscopic surgery. The proportion of colorectal surgeries performed laparoscopically was calculated for each year. Separate descriptive statistics was performed and categorized by age and body mass index (BMI). American Society of Anesthesiology (ASA) classification and emergency case status variables were added to the project to help assess complexity of cases. ResultsDuring the 10-year study period, the number of colorectal cases increased from 3114 in 2005 to 51,611 in 2014 as more hospitals joined NSQIP. A total of 277,376 colorectal cases were identified; of which, 114,359 (41.2%) were performed laparoscopically. The use of laparoscopy gradually increased each year, from 22.7% in 2005 to 49.8% in 2014. Laparoscopic procedures were most commonly performed in the youngest age group (18-49 years), overweight and obese patients (BMI 25-34.9), and in ASA class 1-2 patients. Over the 10-year period, there was a noted increase in the use of laparoscopy in every age, BMI, and ASA category, except ASA 5. The percent of emergency cases receiving laparoscopic surgery also doubled from 5.5% in 2005 to 11.5% in 2014. ConclusionsOver a 10-year period, there was a gradual increase in the use of laparoscopy in colorectal surgery. Further, there was a consistent increase of laparoscopic surgery in all age groups, including the elderly, in all BMI classes, including the obese and morbidly obese, and in most ASA classes, including ASA 3-4, as well as in emergency surgeries. These trends suggest that minimally invasive colorectal surgery appears to be widely adopted and performed on more complex or higher risk patients.

A Randomized Controlled Trial Implementing a Practical and Effective Gynecologic Laparoscopic Curriculum for Obstetrics & Gynecology Residents

As minimally invasive surgery is becoming the standard for gynecologic cases, it is imperative that residents develop strong laparoscopic skills. Research surrounding laparoscopic curricula mostly comes from general surgery such as Fundamentals of Laparoscopic Surgery curriculum (FLS). An FLS-based laparoscopic curriculum was designed and implemented for OB/GYN residents with the goal of demonstrating an improvement in laparoscopic knowledge and skills after exposure.

Single-Incision Transumbilical Surgery (SITUS) versus Single-Port Laparoscopic Surgery and conventional laparoscopic surgery: a prospective randomized comparative study of performance with novices in a dry laboratory

To evaluate the Single-Incision Transumbilical Surgery (SITUS) technique as compared to an established laparoendoscopic single-site surgery (LESS) technique (Single-Port Laparoscopic Surgery, SPLS) and conventional laparoscopy (CLS) in a surgical simulator model. Sixty-three medical students without previous laparoscopic experience were randomly assigned to one of the three groups (SITUS, SPLS and CLS). Subjects were asked to perform five standardized tasks of increasing difficulty adopted from the Fundamentals of Laparoscopic Surgery curriculum. Statistical evaluation included task completion times and accuracy. Overall performances of all tasks (except precision cutting) were significantly faster and of higher accuracy in the CLS and SITUS groups than in the SPLS group (p = 0.004 to p < 0.001). CLS and SITUS groups alone showed no significant difference in performance times and accuracy measurements for all tasks (p = 0.048 to p = 0.989). SITUS proved to be a simple, but highly effective technique to overcome restrictions of SPLS. In a surgical simulator model, novices were able to achieve task performances comparable to CLS and did significantly better than using a port-assisted LESS technique such as SPLS. The demonstrated advantages of SITUS may be attributed to a preservation of the basic principles of conventional laparoscopy, such as the use of straight instruments and an adequate degree of triangulation.

The da vinci robot system eliminates multispecialty surgical trainees' hand dominance in open and robotic surgical settings.

Background and Objectives:Handedness, or the inherent dominance of one hand's dexterity over the other's, is a factor in open surgery but has an unknown importance in robot-assisted surgery. We sought to examine whether the robotic surgery platform could eliminate the effect of inherent hand preference.Methods:Residents from the Urology and Obstetrics/Gynecology departments were enrolled. Ambidextrous and left-handed subjects were excluded. After completing a questionnaire, subjects performed three tasks modified from the Fundamentals of Laparoscopic Surgery curriculum. Tasks were performed by hand and then with the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, California). Participants were randomized to begin with using either the left or the right hand, and then switch. Left:right ratios were calculated from scores based on time to task completion. Linear regression analysis was used to determine the significance of the impact of surgical technique on hand dominance.Results:Ten subjects were enrolled. The mean difference in raw score performance between the right and left hands was 12.5 seconds for open tasks and 8 seconds for robotic tasks (P < .05). Overall left-right ratios were found to be 1.45 versus 1.12 for the open and robot tasks, respectively (P < .05). Handedness significantly differed between robotic and open approaches for raw time scores (P < .0001) and left-right ratio (P = .03) when controlling for the prior tasks completed, starting hand, prior robotic experience, and comfort level. These findings remain to be validated in larger cohorts.Conclusion:The robotic technique reduces hand dominance in surgical trainees across all task domains. This finding contributes to the known advantages of robotic surgery.

Construct Validity of a Novel Side-On Approach to Established Laparoscopic Simulation Curriculum

Fundamentals of Laparoscopic Surgery (FLS) has been validated and used by General Surgeons since 2008. Other subspecialties have implemented FLS training into their training. In the FLS curriculum, as in standard general surgery laparoscopic procedures, the surgeon operates from the midline, head-on, in axis with instrumentation and surgical field. In contrast, most gynecologic procedures are performed from side-on orientation with the operative field in line with the camera axis, but lateral to the surgeon.

Does 3D imaging improve laparoscopic intracorporeal suturing skill acquisition in novices and trainee surgeons?

s / International Journal of Surgery 11 (2013) 686e745 706 ABSTRACTS 1447: DOES 3D IMAGING IMPROVE LAPAROSCOPIC INTRACORPOREAL SUTURING SKILL ACQUISITION IN NOVICES AND TRAINEE SURGEONS? Walid Elbakbak , Badriya Alaramim, Amina Bouhelal , Shah-Jalal Sarker , Bijendra Patel . Barts Cancer institue, London, UK; Royal London Hospital, London, UK. Aims: To objectively evaluate and compare the effects of 3D versus 2D vision system on novice and surgeons performing laparoscopic intracorporeal suturing in terms of performance times, number of repetitions and errors in standardised laboratory settings. Methods: Thirty novices (medical-students) and twenty four core surgical trainees (year 1 &2) were randomised between two vision systems (3D or 2D) stratified by gender. Candidates performed laparoscopic intracorporeal suturing according to the validated fundamentals of laparoscopic surgery (FLS) curriculum until task proficiency is achieved. Parameter measured were the total time to reach task proficiency, number of repetitions and task errors. Results: We concluded that the performance time and repetitions while performing laparoscopic suturing under 3D and 2D vision systems were similar but a trend towards fewer errors and better precision score was observed in 3D vision in both novices and trainees. The novice participant's error score was statically significant (P1⁄40.002). Conclusion: Acquiring laparoscopic suturing skills using 3D vision system is as effective as conventional 2D laparoscopy with no statistical difference in time, number of repetitions and measured error rates in reaching proficiency using FLS curriculum. However, there is a trend towards fewer errors and better precision score in candidates performing under 3D vision. 1449: IMPACT OF EWTD ON PATIENT CARE AND TRAINING e EXPERIENCE OF A DISTRICT GENERAL HOSPITAL Dilraj Bilku, David Andrew, Suresh Pillai. United Lincolnshire Hospitals NHS

The fundamentals of laparoscopic surgery: a validated curriculum to teach laparoscopic skills and knowledge in obstetrics and gynecology residents

The Fundamentals of Laparoscopic Surgery (FLS) program is a validated curriculum to teach basic laparoscopic knowledge and skill; passage of the FLS examination is now required for General Surgery board certification. Our goal was to assess the FLS curriculum as a model to teach basic laparoscopic skills and knowledge for Obstetrics and Gynecology (Ob-Gyn) residents.

Blinded Assessment of Operative Performance After Fundamentals of Laparoscopic Surgery in Gynecology Training

Study ObjectiveTo determine the pass rate for the Fundamentals of Laparoscopic Surgery (FLS) examination among senior gynecology residents and fellows and to find whether there is an association between FLS scores and previous laparoscopic experience as well as laparoscopic intraoperative (OR) skills assessment. DesignProspective cohort study (Canadian Task Force classification II-2). SettingThree gynecology residency training programs. ParticipantsThird- and fourth-year gynecology residents and urogynecology fellows. InterventionsAll participants participated in the FLS curriculum, written and manual skills examination, and completed a survey reporting baseline characteristics and opinions. Fourth-year residents and fellows underwent unblinded and blinded pre- and post-FLS OR assessments. Objective OR assessments of fourth-year residents after FLS were compared with those of fourth-year resident controls who were not FLS trained. Measurements and Main ResultsTwenty-nine participants were included. The overall pass rate was 76%. The pass rate for third- and fourth-year residents and fellows were 62%, 85%, and 100%, respectively. A trend toward improvement in OR assessments was observed for fourth-year residents and fellows for pre-FLS curriculum compared with post-FLS testing, and FLS-trained fourth-year residents compared with fourth-year resident controls; however, this did not reach statistical significance. Self-report of laparoscopic case load experience of >20 cases was the only baseline factor significantly associated with passing the FLS examination (p = .03). ConclusionThe FLS pass rate for senior residents and fellows was 76%, with higher pass rates associated with increasing levels of training and laparoscopic case experience.

The traveling salesman problem in surgery: economy of motion for the FLS Peg Transfer task

In the Peg Transfer task in the Fundamentals of Laparoscopic Surgery (FLS) curriculum, six peg objects are sequentially transferred in a bimanual fashion using laparoscopic instruments across a pegboard and back. There are over 268 trillion ways of completing this task. In the setting of many possibilities, the traveling salesman problem is one where the objective is to solve for the shortest distance traveled through a fixed number of points. The goal of this study is to apply the traveling salesman problem to find the shortest two-dimensional path length for this task. A database platform was used with permutation application output to generate all of the single-direction solutions of the FLS Peg Transfer task. A brute-force search was performed using nested Boolean operators and database equations to calculate the overall two-dimensional distances for the efficient and inefficient solutions. The solutions were found by evaluating peg object transfer distances and distances between transfers for the nondominant and dominant hands. For the 518,400 unique single-direction permutations, the mean total two-dimensional peg object travel distance was 33.3 ± 1.4 cm. The range in distances was from 30.3 to 36.5 cm. There were 1,440 (0.28 %) of 518,400 efficient solutions with the minimized peg object travel distance of 30.3 cm. There were 8 (0.0015 %) of 518,400 solutions in the final solution set that minimized the distance of peg object transfer and minimized the distance traveled between peg transfers. Peg objects moved 12.7 cm (17.4 %) less in the efficient solutions compared to the inefficient solutions. The traveling salesman problem can be applied to find efficient solutions for surgical tasks. The eight solutions to the FLS Peg Transfer task are important for any examinee taking the FLS curriculum and for certification by the American Board of Surgery.

Gynecologic Trainee Opinions on the Fundamentals of Laparoscopic Surgery Curriculum

The Fundamentals of Laparoscopic Surgery (FLS) is a validated curriculum and exam used to assess laparoscopic knowledge and skills for general surgery residents. There are few studies evaluating the value of FLS in gynecology (Gyn) training. The objectives of this study were to: 1) evaluate resident and fellow opinions of FLS certification; and 2) assess if demographics affect FLS pass rates.

Value of fundamentals of laparoscopic surgery training in a fourth-year medical school advanced surgical skills elective

BackgroundFew data are available describing the benefits of initiating fundamentals of laparoscopic surgery (FLS) training during medical school. We hypothesized that an intense 1-month surgical skills elective that included FLS task training for fourth-year medical students (MS4s) would result in performance levels indistinguishable from graduating chief residents (PGY5) who had received clinical skill training and access to self-guided FLS curriculum. MethodsFrom July 2007 through June 2011, 114 MS4s participated in a 1-month advanced surgical skills elective. The curriculum for the elective included cadaver dissections, patient management presentations, and surgical skill training (open surgical skills and basic laparoscopic skills modules performed on FLS trainers and virtual reality laparoscopic simulators). From June 2009 through June 2011, 21 PGY5s graduated who had never received formalized FLS skills training. These residents were tested on FLS by a certified proctor and the results recorded. The performance outcome measure was task completion time. Unpaired Student's t-test was used to compare the performance measures for each group. ResultsAll PGY5s achieved FLS certification on their first attempt and completed enough cases for graduation. The MS4 group showed significantly better performance than the PGY5 group in the peg transfer and circle cut (P < 0.05). No difference was seen in the knot tying tasks between the two groups (P > 0.05) ConclusionsIncorporating FLS training into a 1 month-long medical school surgery elective enabled MS4s to achieve FLS performance similar to, or better than, the performance achieved by PGY5 surgery residents. We support the integration of FLS skills task training as a standard part of the skills training curriculum for medical students.