The Impact of Simulation Based Training on the Fundamentals of Endoscopic Surgery Performance Examination

The Fundamentals of Endoscopic Surgery (FES) Program was developed to help meet the educational needs of surgeons and surgical trainees performing flexible gastrointestinal endoscopy. During the development, there were multiple published reports establishing the validity evidence, which influenced the American Board of Surgery (ABS) to incorporate FES as a key component of its Flexible Endoscopy Curriculum (FEC). In March of 2014, the ABS announced that completion of the FEC would be required for all applicants beginning with the 2017 -2018 graduating class. The role of simulation-based training in FES skills test performance after this requirement has not been evaluated. There is a concern voiced by many trainees and program directors that since the FES skills test is conducted in the simulated environment, simulation-based practice is required for passing. We sought to answer the following research questions: 1) What is the relationship between time spent on simulation-based training and FES skills test score? 2) Is simulation-based training required to pass the FES skills test? 3) Is selfreported simulation based training or self-reported clinical endoscopy training a better predictor of FES skills test performance? 4) Has simulation based training in flexible endoscopy increased since the ABS implemented the FEC? We analyzed a de-identified database of over 3000 participants and identified just over 2000 general surgery residents who took the FES skills test as part of their ABS requirement. Just over 700 participants responded to the question about simulation-based practice. We showed that the FES skills test continues to be an excellent measurement of the task work required to perform clinical endoscopy. There is clearly no credible threat to the validity of the FES skills test from any construct irrelevant variance resulting from a need for simulation based practice to pass the FES skills test. Similarly, the amount of practice is not predictive of passing, vi i SUMMARY (Continued) but simulation-based practice can improve performance on certain FES tasks, especially for those test takers with less clinical endoscopy experience. There is no strong evidence to support a dramatic increase in simulation-based practice by general surgery residents after the FEC requirement was announced. For residents who have met the clinical experience requirements of the FEC, the gender effect seen in previous work seems to be reduced and glove size emerges as the more important predictor of performance. Finally, with some minimal changes in how data are collected, the FES Program could improve future analysis of the relationship between simulation-based training and FES skills test performance.