#1035 2004 · American College of Surgeons / SAGES / American Board of Surgery · Healthcare and surgery
Surgery boards stopped certifying laparoscopic skill by case count and tested it on a box
问题
A resident's logged case count said nothing about whether their hands could safely perform minimally invasive surgery
背景
Laparoscopic surgery, operating through small incisions while watching a video monitor rather than looking directly at the tissue, demands a distinct hand-eye coordination general surgery training had never explicitly tested; residents were credentialed mainly on how many procedures they had logged assisting or performing, a count that said nothing about the specific skill.
Surgeons Gerald Fried and colleagues built Fundamentals of Laparoscopic Surgery (FLS), pairing a written exam with a hands-on skills test — peg transfer, pattern cutting, and suturing tasks performed on a physical trainer box under time and accuracy scoring, not a video game but a real manipulation task.
换别人会怎么做
Keep certifying surgeons on completed case counts and a written exam of surgical knowledge, the credentialing method every prior generation of general surgeons had been certified through.
他们看到了什么
A case count measures exposure, not competence; the hand-eye demands could be isolated outside a patient — so instead of trusting repetition to produce skill, Fried's team built a bench test that measured it directly.
那一手
Candidates for general surgery board certification must pass both the FLS written module and the manual skills station, physically performing five timed tasks — including intracorporeal suturing — on the standardized trainer box, with proctors scoring precision and time exactly as an operating room would demand.
为什么管用
Because the trainer-box tasks isolate the precise coordination laparoscopic surgery requires — working from a flat video image while manipulating instruments through a fixed port — a candidate's timed accuracy on the box reflects the same underlying skill an operating room needs, letting a five-task bench test substitute for years of unverified case exposure.
值了多少
A 2004 study found FLS scores predicted real OR performance; the Board made it mandatory for eligibility from the 2009-2010 class on.
什么时候会失灵
A bench test only certifies the narrow motor skill it isolates, not clinical judgment or handling real tissue and bleeding — some residency programs have since questioned whether FLS scores alone predict full operative competence, and it was always meant to supplement, not replace, supervised real-case training.
后来呢
FLS is now the accepted international standard for certifying baseline laparoscopic competence and has been adopted or referenced by surgical boards outside the US, cited as the model for turning a physical, hands-on skill test into a mandatory credentialing gate rather than an optional add-on.
资料来源
- [1]ABOG Announces New Eligibility Requirement for Board Certification - FLSFLS Program, 2013flsprogram.org
- [2]ACS and SAGES Recommend FLS Certification for General Surgeons Who Perform LaparoscopyFundamentals of Laparoscopic Surgery Program, 2019flsprogram.org