Abstract
Background
Fundamentals of endoscopic surgery (FES) completion is mandatory for certification by the American Board of Surgery (ABS). As early simulation and competency assessment can bolster development of trainee proficiency, we sought to determine the optimal timing for FES examination by evaluating pass rates based on training level and previous endoscopic experience.
Methods
PGY2-5 residents at a university-based medical center who were novice to FES were assigned to complete FES training and testing. Training year, prior endoscopic experience, and FES exam scores were recorded with pre- and post-test surveys.
Results
Most residents in the program (88%) were able to complete FES training and testing within a single academic year. Most required only a single faculty-led session (88%) to feel confident to take the exam, augmented by varying numbers of independent practice sessions (50% 1–2, 19% 3–5, 27% > 5). After training, most (84%) felt confident that they would pass the exam, and 93% did so on their first attempt. While higher written exam scores were noted in the PGY5 group, there were no other statistically significant differences in overall pass rates or technical exam scores based on PGY level (p = 0.24). A number of previously completed endoscopic cases did not correlate with exam scores (p = 0.24 written, p = 0.91 technical).
Conclusion
Fundamentals of endoscopic surgery (FES) certification can be successfully completed by junior level general surgery residents regardless of previous endoscopic experience. Moving this exam to earlier training years can benefit resident development and preparedness in the clinical setting without negatively impacting pass rates.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Hazey JW, Marks JM, Mellinger JD, et al. Why fundamentals of endoscopic surgery (FES)? Surg Endosc. 2014;28(3):701-703. https://doi.org/10.1007/s00464-013-3299-3
Vassiliou MC, Dunkin BJ, Marks JM, Fried GM. FLS and FES: comprehensive models of training and assessment. Surg Clin North Am. 2010;90(3):535-558. https://doi.org/10.1016/j.suc.2010.02.012
King N, Kunac A, Merchant AM. A Review of Endoscopic Simulation: Current Evidence on Simulators and Curricula. J Surg Educ. 2016;73(1):12-23. https://doi.org/10.1016/j.jsurg.2015.09.001
Testing Information. Fundamentals of Endoscopic Surgery. Published September 10, 2012. Accessed August 25, 2022. https://www.fesprogram.org/testing-information/
Flexible Endoscopy Curriculum | American Board of Surgery. Accessed April 21, 2023. https://www.absurgery.org/default.jsp?certgsqe_fec
Sturm LP, Windsor JA, Cosman PH, Cregan P, Hewett PJ, Maddern GJ. A systematic review of skills transfer after surgical simulation training. Ann Surg. 2008;248(2):166-179. https://doi.org/10.1097/SLA.0b013e318176bf24
Zevin B, Aggarwal R, Grantcharov TP. Surgical simulation in 2013: why is it still not the standard in surgical training? J Am Coll Surg. 2014;218(2):294-301. https://doi.org/10.1016/j.jamcollsurg.2013.09.016
Vassiliou MC, Dunkin BJ, Fried GM, et al. Fundamentals of endoscopic surgery: creation and validation of the hands-on test. Surg Endosc. 2014;28(3):704-711. https://doi.org/10.1007/s00464-013-3298-4
Vassiliou MC, Kaneva PA, Poulose BK, et al. Global Assessment of Gastrointestinal Endoscopic Skills (GAGES): a valid measurement tool for technical skills in flexible endoscopy. Surg Endosc. 2010;24(8):1834-1841. https://doi.org/10.1007/s00464-010-0882-8
Mizota T, Anton NE, Huffman EM, et al. Development of a fundamentals of endoscopic surgery proficiency-based skills curriculum for general surgery residents. Surg Endosc. 2020;34(2):771-778. https://doi.org/10.1007/s00464-019-06827-6
Guzzetta AA, Weis JJ, Hennessy SA, et al. Proficiency-based preparation significantly improves FES certification performance. Surg Endosc. 2018;32(11):4451-4457. https://doi.org/10.1007/s00464-018-6190-4
Dyke C, Franklin BR, Sweeney WB, Ritter EM. Early implementation of Fundamentals of Endoscopic Surgery training using a simulation-based mastery learning curriculum. Surgery. 2021;169(5):1228-1233. https://doi.org/10.1016/j.surg.2020.12.005
Lineberry M, Matthew Ritter E. Psychometric properties of the Fundamentals of Endoscopic Surgery (FES) skills examination. Surg Endosc. 2017;31(12):5219-5227. https://doi.org/10.1007/s00464-017-5590-1
Ritter EM, Taylor ZA, Wolf KR, et al. Simulation-based mastery learning for endoscopy using the endoscopy training system: a strategy to improve endoscopic skills and prepare for the fundamentals of endoscopic surgery (FES) manual skills exam. Surg Endosc. 2018;32(1):413-420. https://doi.org/10.1007/s00464-017-5697-4
Author information
Authors and Affiliations
Contributions
Theresa Wang—substantial contributions to analysis and interpretation of data; drafting and critical revisions of manuscript.
Jennifer Underhill—substantial contributions to conception and design; acquisition, analysis, and interpretation of data; critical revisions of manuscript.
Savanah Renshaw—substantial contributions to conception and design; acquisition and analysis of data; critical revisions of manuscript.
Kelly Haisley—substantial contributions to conception and design; acquisition, analysis, and interpretation of data; drafting and critical revisions of manuscript.
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Wang, T.N., Underhill, J.M., Renshaw, S.K. et al. Optimal Timing of Fundamentals of Endoscopic Surgery (FES) Testing in General Surgery Residency: Early Is Better. J Gastrointest Surg 27, 2893–2898 (2023). https://doi.org/10.1007/s11605-023-05727-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-023-05727-4