Validity of using Fundamentals of Laparoscopic Surgery (FLS) program to assess laparoscopic competence for gynecologists

Background This study was designed to investigate the validity of using the Fundamentals of Laparoscopic Surgery (FLS) program to assess laparoscopic competence among gynecologists. Methods A total of 42 gynecologists with variable surgical training and laparoscopic experience were enrolled for FLS testing which includes a computer-based cognitive examination to assess one's knowledge and a psychomotor portion for manual skills assessment. Prior to testing, participants were surveyed to document their level of surgical training and caseload for common laparoscopic procedures. Participants were required to self-evaluate their confidence in conducting laparoscopic procedures. Upon completion of the FLS test, feedback was collected regarding the use of the FLS program for training and assessing laparoscopic skills of gynecologists. Results Gynecologists with advanced levels of surgical training achieved higher scores in the FLS manual skills test than those with lower levels of training (P = 0.009). The cognitive test, however, failed to show an increased score with greater levels of surgical training (P = 0.457). Regression analyses revealed that a participant's laparoscopic expertise contributed significantly to one's FLS manual skills scores (P = 0.008) beyond surgical training level alone. In contrast, laparoscopic expertise did not reflect changes in the FLS cognitive scores significantly (P = 0.628). Self-reported confidence scores correlated well with FLS manual skills test scores (r = 0.54) but not with the cognitive scores (r = 0.16). Conclusion The manual skills test of the FLS program appropriately measures the level of a gynecologist's psychomotor skills. The FLS cognitive test does not discriminate between advanced and novice surgeons. Modifications of questions used in the cognitive test are necessary to allow better adaptability when applying the FLS program to gynecologists.