Development of a fundamentals of endoscopic surgery proficiency‐based skills curriculum for general surgery residents

  • Tomoko Mizota
  • Nicholas E. Anton
  • Elizabeth M. Huffman
  • Michael J. Guzman
  • Frederick Lane
  • Jennifer N. Choi
  • Dimitrios StefanidisEmail author



Fundamentals of Endoscopic Surgery (FES) has become a board certification requirement for general surgery residents. While the FES program provides a robust didactic curriculum, an endoscopic skills curriculum is lacking for this high stakes assessment. The aims of this study were to develop a proficiency-based endoscopic skills curriculum and assess its effectiveness on success in the FES exam.


Endoscopy experts developed a multiple-choice questionnaire based on the FES online didactics. Five training cases from the GI Mentor II simulator were selected, and expert performance defined proficiency levels for each case. Participating surgery residents were required to review online didactics and achieve proficiency twice on selected simulator cases. The multiple-choice questionnaire, simulator-generated metrics of two endoscopy cases, Global Assessment of Gastrointestinal Endoscopic Skills (GAGES), NASA-Task Load Index (TLX), and the manual portion of the FES exam were used for assessment before and after training. The curriculum was implemented either alongside a clinical endoscopy rotation or independent of the rotation. Clinical endoscopic skills of participants with a dedicated rotation were assessed using GAGES.


Twenty-eight general surgery residents (PGY 2–5) participated in the study, of which 25 (89%) completed the curriculum. Scores of the multiple-choice questionnaire and all simulator-generated metrics improved in the post-training assessment, with the exception of the percentage of mucosal surface examined, which was slightly decreased. Simulated and clinical GAGES scores and the NASA-TLX score improved after training. Performance scores on four of five FES exam tasks were significantly improved.


The proficiency-based endoscopic skills curriculum was successfully implemented both alongside the clinical endoscopy rotation and independent of the rotation. Participating residents acquired skills to pass the FES exam. This curriculum will be valuable to general surgery residency programs.


Competency Simulation Curriculum development Mastery learning Colonoscopy 



We thank the FES committee of SAGES for their input with the study, and Drs. William W Hope, Ranjan Sudan, Raghid S Bitar, and Mark Manwaring for their contribution to the curriculum development. We acknowledge Victoria G Dodge for the editing of this manuscript.


This study was funded by Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) through one of their FES research grants. Drs. Mizota, Huffman, Guzman, Lane, Choi, Stefanidis, and Mr. Anton have no conflict of interest or financial ties to disclose.


This study was funded by a grant from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Tomoko Mizota
    • 1
  • Nicholas E. Anton
    • 1
  • Elizabeth M. Huffman
    • 1
  • Michael J. Guzman
    • 1
  • Frederick Lane
    • 1
  • Jennifer N. Choi
    • 1
  • Dimitrios Stefanidis
    • 1
    Email author
  1. 1.Department of SurgeryIndiana University School of MedicineIndianapolisUSA

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