Surgical Endoscopy

, Volume 24, Issue 10, pp 2453–2457 | Cite as

Proficiency-based Fundamentals of Laparoscopic Surgery skills training results in durable performance improvement and a uniform certification pass rate

  • Madelyn E. Rosenthal
  • E. Matt Ritter
  • Mouza T. Goova
  • Antonio O. Castellvi
  • Seifu T. Tesfay
  • Elisabeth A. Pimentel
  • Robert Hartzler
  • Daniel J. Scott



The authors have previously documented a 100% certification pass rate immediately after a proficiency-based skills training curriculum for the Fundamentals of Laparoscopic Surgery (FLS) program. This study aimed to determine the durability of skills acquired after initial training.


For this study, 21 novice medical students were enrolled in institutional review board (IRB)-approved protocols at two institutions. As previously reported, all the participants successfully completed a structured proficiency-based training curriculum by practicing the five FLS tasks in a distributed fashion over a 2-month period. Pre- and posttesting was conducted, and standard testing metrics were used. The participants were recruited for repeat testing 6 months (retention 1) and 1 year (retention 2) after initial curriculum completion. Of the original 21 students, 15 (10 at University of Texas Southwestern and 5 at Uniformed Services University) were available and agreed to participate. The participants had no additional skills lab training and minimal clinical laparoscopic exposure.


None of the 15 participants demonstrated proficiency at the initial pretest (mean score, 146 ± 65), and performance showed significant improvement (p < 0.001) at the posttest (469 ± 20). The participants retained a very high level of performance at retention 1 (437 ± 39; 93% retention of the posttest score) and retention 2 (444 ± 55; 95% retention of the posttest score). Their performance at both retention testing-intervals was sufficient for passing the certification exam (270 cutoff score for passing) with a comfortable margin. There were no significant differences in performance between the two institutions at any time points.


The proficiency-based FLS skills curriculum reliably results in a high level of skill retention, even in the absence of ongoing simulator-based training or clinical experience. This curriculum is suitable for widespread implementation.


FLS Fundamentals of Laparoscopy Proficiency-based training Simulation Surgical education 



Daniel Scott has a licensing agreement with Ethicon Endosurgery regarding Magnetic Anchoring and Guidance Systems (MAGS). He also has research grants with Ethicon Endosurgery. Dr. Scott is a speaker for Covidien and also has research grants with this company. He is a speaker for Allergan and has research and equipment grants with Storz. Dr. Scott is a consultant for Accelerated Technologies Incorporated and receives both honoraria and reimbursed travel for any activities that may involve any role previously described. Madelyn Rosenthal, Matt Ritter, Antonio Castellvi, Seifu Tesfay, and Mouza Goova have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Madelyn E. Rosenthal
    • 1
  • E. Matt Ritter
    • 2
  • Mouza T. Goova
    • 1
  • Antonio O. Castellvi
    • 1
  • Seifu T. Tesfay
    • 1
  • Elisabeth A. Pimentel
    • 2
  • Robert Hartzler
    • 1
  • Daniel J. Scott
    • 1
  1. 1.Southwestern Center for Minimally Invasive SurgeryUT Southwestern Medical CenterDallasUSA
  2. 2.Uniformed Services UniversityBethesdaUSA

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