Certification pass rate of 100% for fundamentals of laparoscopic surgery skills after proficiency-based training

Background: The fundamentals of laparoscopic surgery (FLS) program has been extensively validated for use as a high-stakes examination for certification purposes, but optimal methods for its use in skills training have not been described. This study aimed to investigate the feasibility of implementing a proficiency-based FLS skills training curriculum and to evaluate its effectiveness in preparing trainees for certification. Methods: For this study, 21 novice medical students at two institutions viewed video tutorials, then performed one repetition of the five FLS tasks as a pretest. The pretests were scored using standard testing metrics. The trainees next practiced the tasks over a 2-month period until they achieved proficiency for all the tasks. A modified on-the-fly scoring system based on expert-derived performance was used. The trainees were posttested using the high-stakes examination format. Results: No trainee passed the certification examination at pretesting. The trainees achieved proficiency for 96% of the five tasks during training, which required 9.7 ± 2.4 h (range, 6-14 h) and 119 ± 31 repetitions (range, 66-161 repetitions). The trainees rated the proficiency levels as "moderately difficult" (3.0 ± 0.7 on a 5-point scale) and "highly appropriate" (4.7 ± 0.1 on a 5-point scale). At posttesting, 100% of the trainees passed the certification examination and demonstrated significant improvement compared with pretesting for normalized score (468 ± 24 vs 126 ± 75; p < 0.001), self-rated laparoscopic comfort (89.4% vs 4.8%; p < 0.001), and skill level (3.6 ± 0.9 vs 1.2 ± 0.5; p < 0.001, 5-point scale). Conclusions: This proficiency-based curriculum is feasible for training novices and uniformly allows sufficient skill acquisition for FLS certification. Endorsed by the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), this curriculum is available for use as an optimal method for FLS skills training. More widespread adoption of this curriculum is encouraged.