Ensuring competency: Are fundamentals of laparoscopic surgery training and certification necessary for practicing surgeons and operating room personnel?

Melanie L. Hafford, Kent R. Van Sickle, Ross E. Willis, Todd D. Wilson, Kristine Gugliuzza, Kimberly M. Brown, Daniel J. Scott

Research output: Contribution to journalArticlepeer-review

66 Scopus citations


Background: Certification in fundamentals of laparoscopic surgery (FLS) is required by the American board of surgery for graduating residents. This study aimed to evaluate the feasibility and need for certifying practicing surgeons and to assess proficiency of operating room (OR) personnel. Methods: Through a patient safety and health care delivery effectiveness grant, investigators at four state medical schools received funding for FLS certification of all attending surgeons and OR personnel credentialed in laparoscopy. Data were voluntarily collected under an institutional review board-approved protocol. Surgeons performed a single repetition of the FLS tasks oriented to the FLS proficiency-based curriculum and online cognitive materials and were encouraged to self-practice. The FLS certification examination was administered 2 months later under standard conditions. Operating room nurses and scrub technicians were enrolled in a curriculum with cognitive materials and a multistation skills practicum. Baseline and completion questionnaires were administered. Performance was assessed using signed-rank and χ2 analysis. Results: The study aimed to enroll 99 surgeons. Subsequently, 87 surgeons completed at least one portion of the curriculum, 72 completed the entire curriculum (73 % compliance), 83 completed the baseline skills assessment, and 27 (33 %) failed. The self-reported practice time was 3.7 ± 2.5 h. At certification (n = 76), skills performance had improved from 317 ± 102.9 to 402 ± 54.2 (p < 0.0001). One surgeon (1.3 %) failed the skills certification, and nine (11.8 %) failed the cognitive exam. Remediation was completed by six surgeons. Of the 64 enrolled OR personnel, 22 completed the curriculum (34 % compliance). All achieved proficiency at skills, and 60 % passed the cognitive exam. Conclusions: This study demonstrated that FLS certification for practicing surgeons and proficiency verification for OR personnel are feasible. A baseline skills failure rate of 33 % and a certification failure rate of 13 % suggest that FLS certification may be necessary to ensure surgeon competency. Fortunately, with only moderate practice, significant improvement can be achieved.

Original languageEnglish (US)
Pages (from-to)118-126
Number of pages9
JournalSurgical Endoscopy
Issue number1
StatePublished - Jan 2013
Externally publishedYes


  • Certification
  • Credentialing
  • FLS
  • Fundamentals of laparoscopic surgery
  • Operating room nurses
  • Scrub technicians
  • Surgeons

ASJC Scopus subject areas

  • Surgery


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