# We’re talking about practice: examining the shifting role of FLS in surgical education

## TL;DR

This study examines how the FLS program influences laparoscopic surgery training and practice habits among surgical residents.

## Contribution

The study identifies a shift in FLS's role and its impact on residents' laparoscopic practice and skill transferability.

## Key findings

- Residents practice laparoscopy primarily to complete FLS, not for skill development.
- FLS skills are perceived as limited in their transferability to complex laparoscopic cases.
- Practice frequency decreases after FLS completion, with most residents focusing only on FLS-related skills.

## Abstract

In 2004, the Society of Gastrointestinal and Endoscopic Surgeons launched the fundamentals of laparoscopic surgery (FLS) program to ensure surgeons had the minimum knowledge, judgment, and technical skills to perform basic laparoscopic operations. Since FLS’s implementation, laparoscopic surgery rates have risen, and its role as a summative assessment has shifted as programs introduce FLS earlier in training. We hypothesize that surgical trainees only practice laparoscopy in a box trainer to complete FLS and seek to define the relationship of FLS and attitudes toward the independent practice of laparoscopy in general surgery trainees.

A survey was distributed to three general surgery residency programs using five-point Likert, nominal, and ratio scales to collect data on independent laparoscopy practice, opinions on FLS skills, and its role in preparing for operative cases. Data analysis focused on response rates of answer choices.

Of the 88 residents polled, thirty-one residents responded to the survey (35%), of which 45.2% (14) have passed the FLS exam. The first-time pass rate was 100%. Approximately, one-third of residents who completed FLS state they regularly practiced laparoscopy before FLS completion (28.6% agree, 7.1% strongly agree). That number decreased to 7.1% after FLS completion (7.1% agree, 0% strongly agree). About half of residents only practice skills from the FLS skills test (19.4% strongly agree, 29.0% agree). Yet, only a third (32.3%) agreed that FLS skills are transferable to complex laparoscopy cases.

Simulated laparoscopic practice decreases after completion of FLS, and the majority of residents only engage in practice using FLS skills. FLS has become the main driver of independent laparoscopic practice for many residents. An emphasis on self-directed learning and expanded laparoscopic skills taught in simulation could increase time spent practicing and more easily transfer skills to the operating room.