Surgical Endoscopy

, Volume 27, Issue 11, pp 4033–4037 | Cite as

Feasibility of remote administration of the Fundamentals of Laparoscopic Surgery (FLS) skills test

  • Allan Okrainec
  • Melina Vassiliou
  • Andrew Kapoor
  • Kristen Pitzul
  • Oscar Henao
  • Pepa Kaneva
  • Timothy Jackson
  • E. Matt Ritter



Fundamentals of Laparoscopic Surgery (FLS) certification testing currently is offered at accredited test centers or at select surgical conferences. Maintaining these test centers requires considerable investment in human and financial resources. Additionally, it can be challenging for individuals outside North America to become FLS certified. The objective of this pilot study was to assess the feasibility of remotely administering and scoring the FLS examination using live videoconferencing compared with standard onsite testing.


This parallel mixed-methods study used both FLS scoring data and participant feedback to determine the barriers to feasibility of remote proctoring for the FLS examination. Participants were tested at two accredited FLS testing centers. An official FLS proctor administered and scored the FLS exam remotely while another onsite proctor provided a live score of participants’ performance. Participant feedback was collected during testing. Interrater reliabilities of onsite and remote FLS scoring data were compared using intraclass correlation coefficients (ICCs). Participant feedback was analyzed using modified grounded theory to identify themes for barriers to feasibility.


The scores of the remote and onsite proctors showed excellent interrater reliability in the total FLS (ICC 0.995, CI [0.985–0.998]). Several barriers led to critical errors in remote scoring, but most were accompanied by a solution incorporated into the study protocol. The most common barrier was the chain of custody for exam accessories.


The results of this pilot study suggest that remote administration of the FLS has the potential to decrease costs without altering test-taker scores or exam validity. Further research is required to validate protocols for remote and onsite proctors and to direct execution of these protocols in a controlled environment identical to current FLS test administration.


Distance learning Fundamentals of Laparoscopic Surgery Surgical education Telesimulation 



Allan Okrainec is a consultant for Covidien and receives fellowship support from Covidien. Melina Vassiliou reports research and receives fellowship support from Covidien. Andrew Kapoor, Kristen Pitzul, Oscar Henao, Pepa Kaneva, Timothy Jackson, and E. Matthew Ritter have no conflicts of interests or financial ties to disclose.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Allan Okrainec
    • 1
    • 2
  • Melina Vassiliou
    • 3
  • Andrew Kapoor
    • 2
  • Kristen Pitzul
    • 1
  • Oscar Henao
    • 1
  • Pepa Kaneva
    • 3
  • Timothy Jackson
    • 1
    • 2
  • E. Matt Ritter
    • 4
  1. 1.Temerty/Chang Telesimulation Centre, Toronto Western Hospital, University Health NetworkTorontoCanada
  2. 2.Department of SurgeryUniversity of TorontoTorontoCanada
  3. 3.Montreal General Hospital, McGill UniversityMontrealCanada
  4. 4.Uniformed Services UniversityBethesdaUSA

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