Surgeons as Educators A Guide for Academic Development and Teaching Excellence

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incorporated into the manual skills training practicum portion of the Society of

American Gastrointestinal and Endoscopic Surgeons (SAGES) Fundamentals of

Laparoscopic Surgery (FLS) training program. SAGES began development of the

FLS curriculum back in the late 1990s with four goals in mind; to improve cognitive

and psychomotor skills, to focus on uniquely laparoscopic material, to avoid anatomic

specificity, and to both assess and instruct MIS skills [ 22 ]. Completion of the FLS

curriculum requires completion of didactic material, originally via CD-ROM and now

via online courseware/assessment in addition to training and testing of the five manual

skills on the MISTELS portable pelvic video box trainer. MISTELS was purposefully

selected over VR simulation options to keep site costs low as well as the fact that the

system is easily transported and reproduced. MISTELS includes an opaque box

trainer, optical system, and laparoscopic instruments that resemble those found in the

OR. FLS box trainer scores have been shown to be independently predictive of intra-

operative laparoscopic performance as measured by the Global Operative Assessment

of Laparoscopic Skills (GOALS), described in more detail below. This lead the FLS

training program to be recognized as the current “gold standard” in laparoscopic train-

ing and resulting in its rapid adoption as a primary component of many general sur-

gery residency programs [ 6 – 8 ]. Furthermore, recently SAGES has developed a

technical skills curriculum specifically designed for use in residency training pro-

grams, which can be found at http://www.flsprogram.org/index/

fls-program-description/.

Before trainees begin the psychomotor skills training component, they must first

complete the didactic curriculum, which divides laparoscopic skills across five

modules, listed below in Fig. 5.1 [ 6 – 8 ].

Manual skills training includes exercises done with the current version of the

MISTELS box trainer, which is referred to as the FLS box trainer. Each exercise has

Module I – Preoperative Considerations

•§Laparoscopic Equipment

•§Energy Sources

•§OR Set Up

•§Patient Selection / Preoperative Assessment

•§Preoperative Assessment

Module II – Intraoperative Considerations

•§Anesthesia & Patient Positioning

•§Pneumoperitoneum Establishment & Trocar Placement

•§Physiology of Pneumoperitoneum

•§Exiting the Abdomen

Module III – Basic Laparoscopic Procedures

•§Current laparoscopic procedures

•§Diagnostic Laparoscopy

•§Biopsy

•§Laparoscopic Suturing

•§Hemorrhage & Hemostasis

Module IV – Postoperative Care and Complications

•§Postoperative Care

•§Postoperative Complications

Module V – Manual Skills Training

Fig. 5.1 FLS skill module progression

E.I. George et al.