Surgeons as Educators A Guide for Academic Development and Teaching Excellence

(Ben Green) #1
56

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.
Free download pdf