Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 3/2010

01-03-2010

Malpractice carrier underwrites Fundamentals of Laparoscopic Surgery training and testing: a benchmark for patient safety

Authors: Alexandre Y. Derevianko, Steven D. Schwaitzberg, Shawn Tsuda, Limaris Barrios, David C. Brooks, Mark P. Callery, David Fobert, Noel Irias, David W. Rattner, Daniel B. Jones

Published in: Surgical Endoscopy | Issue 3/2010

Login to get access

Abstract

Background

Fundamentals of Laparoscopic Surgery (FLS) is a validated program developed by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) to educate and assess competency in minimally invasive surgery (MIS). This study reports the first malpractice carrier–sponsored FLS course for surgeons in practice underwritten by the Controlled Risk Insurance Company of Harvard’s Risk Management Foundation (CRICO/RMF). The study investigated the participating surgeons’ pattern of MIS skills acquisition, subjective laparoscopic comfort level, operative activity, and perception of the FLS role in surgical education, credentialing, and patient safety.

Methods

A 1-day postgraduate continuous medical education (CME) course consisted of didactic presentations of the leading MIS faculty, proctored FLS hands-on training, psychomotor testing, and cognitive computer-based examination. Voluntary anonymous pre- and postcourse surveys were distributed to the participants at registration and at completion of both the didactic teaching and the skills modules of the program.

Results

The course was attended by 37 practicing surgeons in the Harvard system, and 86% of the survey forms were returned. The major driving forces for attending the course were directive from the chief/chairman (50%), improvement in MIS didactic knowledge (56%), and the belief that FLS would become a standard such as advanced trauma life support (ATLS), advanced cardiac life support (ACLS), or the like (53%). Surgeons reported that the FLS exam content was appropriate (Likert 4.41 ± 0.91) and that mastery of the course material would improve safety (Likert 4.13 ± 0.79) and technical knowledge of MIS (Likert 4.03 ± 1.00).

Conclusions

This unique cooperative effort between a liability carrier, a professional surgical society, and proactive surgeons should be considered a model for advancing competency and patient safety. The survey results indicate a positive view of FLS in surgical training, safety, and MIS education.
Literature
1.
Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) (2007) Fundamentals of Laparoscopic Surgery (FLS) Program. SAGES, Los Angeles, CA
2.
Peters JH, Fried GM, Swanstrom LL et al (2004) Development and validation of a comprehensive program of education and assessment of the basic fundamentals of laparoscopic surgery. Surgery 135(1):21–27CrossRefPubMed
3.
Swanstrom LL, Fried GM, Hoffman KI, Soper NJ (2006) Beta test results of a new system assessing competence in laparoscopic surgery. J Am Coll Surg 202(1):62–69CrossRefPubMed
4.
Fried GM, Feldman LS, Vassiliou MC et al (2004) Proving the value of simulation in laparoscopic surgery. Ann Surg 240(3):518–525 (discussion 525–528)CrossRefPubMed
5.
Feldman LS, Hagarty SE, Ghitulescu G et al (2004) Relationship between objective assessment of technical skills and subjective in-training evaluations in surgical residents. J Am Coll Surg 198(1):105–110CrossRefPubMed
6.
Stefanidis D, Sierra R, Korndorffer JR Jr et al (2006) Intensive continuing medical education course training on simulators results in proficiency for laparoscopic suturing. Am J Surg 191(1):23–27CrossRefPubMed
7.
Ritter EM, Scott DJ (2007) Design of a proficiency-based skills training curriculum for the fundamentals of laparoscopic surgery. Surg Innov 14(2):107–112CrossRefPubMed
8.
Fraser SA, Klassen DR, Feldman LS et al (2003) Evaluating laparoscopic skills: setting the pass/fail score for the MISTELS system. Surg Endosc 17(6):964–967CrossRefPubMed
9.
McCluney AL, Vassiliou MC, Kaneva PA et al (2007) FLS simulator performance predicts intraoperative laparoscopic skill. Surg Endosc 21(11):1991–1995CrossRefPubMed
10.
Stefanidis D, Korndorffer JR Jr, Markley S et al (2006) Proficiency maintenance: impact of ongoing simulator training on laparoscopic skill retention. J Am Coll Surg 202(4):599–603CrossRefPubMed
11.
Scott DJ, Ritter EM, Tesfay ST et al (2008) Certification pass rate of 100% for fundamentals of laparoscopic surgery skills after proficiency-based training. Surg Endosc 22(8):1887–1893CrossRefPubMed
12.
Fried GM (2006) Lessons from the surgical experience with simulators: incorporation into training and utilization in determining competency. Gastrointest Endosc Clin North Am 16(3):425–434CrossRef
13.
Fraser SA, Feldman LS, Stanbridge D, Fried GM (2005) Characterizing the learning curve for a basic laparoscopic drill. Surg Endosc 19(12):1572–1578CrossRefPubMed
14.
Dauster B, Steinberg AP, Vassiliou MC et al (2005) Validity of the MISTELS simulator for laparoscopy training in urology. J Endourol 19(5):541–545CrossRefPubMed
15.
Derossis AM, Antoniuk M, Fried GM (1999) Evaluation of laparoscopic skills: a 2-year follow-up during residency training. Can J Surg 42(4):293–296PubMed
16.
Derossis AM, Bothwell J, Sigman HH, Fried GM (1998) The effect of practice on performance in a laparoscopic simulator. Surg Endosc 12(9):1117–1120CrossRefPubMed
17.
Derossis AM, Fried GM, Abrahamowicz M et al (1998) Development of a model for training and evaluation of laparoscopic skills. Am J Surg 175(6):482–487CrossRefPubMed
18.
Fried GM, Derossis AM, Bothwell J, Sigman HH (1999) Comparison of laparoscopic performance in vivo with performance measured in a laparoscopic simulator. Surg Endosc 13(11):1077–1181 (discussion 1082)CrossRefPubMed
19.
Vassiliou MC, Ghitulescu GA, Feldman LS et al (2006) The MISTELS program to measure technical skill in laparoscopic surgery: evidence for reliability. Surg Endosc 20(5):744–747CrossRefPubMed
20.
Feldman LS, Sherman V, Fried GM (2004) Using simulators to assess laparoscopic competence: ready for widespread use? Surgery 135(1):28–42CrossRefPubMed
21.
Fried GM (2005) The Steinberg-Bernstein Centre for minimally invasive surgery at McGill University. Surg Innov 12(4):345–348CrossRefPubMed
22.
Gunther S, Rosen J, Hannaford B, Sinanan M (2007) The red DRAGON: a multimodality system for simulation and training in minimally invasive surgery. Stud Health Technol Inform 125:149–154PubMed
23.
Hsu KE, Man FY, Gizicki RA et al (2008) Experienced surgeons can do more than one thing at a time: effect of distraction on performance of a simple laparoscopic and cognitive task by experienced and novice surgeons. Surg Endosc 22(1):196–201CrossRefPubMed
24.
Keyser EJ, Derossis AM, Antoniuk M et al (2000) A simplified simulator for the training and evaluation of laparoscopic skills. Surg Endosc 14(2):149–153CrossRefPubMed
25.
Korndorffer JR Jr, Dunne JB, Sierra R et al (2005) Simulator training for laparoscopic suturing using performance goals translates to the operating room. J Am Coll Surg 201(1):23–29CrossRefPubMed
26.
Ritter EM, Kindelan TW, Michael C et al (2007) Concurrent validity of augmented reality metrics applied to the fundamentals of laparoscopic surgery (FLS). Surg Endosc 21(8):1441–1445CrossRefPubMed
27.
Powers KA, Rehrig ST, Irias N et al (2008) Simulated laparoscopic operating room crisis: an approach to enhance the surgical team performance. Surg Endosc 22(4):885–900CrossRefPubMed
28.
Stefanidis D, Acker C, Heniford BT (2008) Proficiency-based laparoscopic simulator training leads to improved operating room skill that is resistant to decay. Surg Innov 15(1):69–73CrossRefPubMed
29.
Stefanidis D, Korndorffer JR Jr, Black FW et al (2006) Psychomotor testing predicts rate of skill acquisition for proficiency-based laparoscopic skills training. Surgery 140(2):252–262CrossRefPubMed
30.
Stefanidis D, Korndorffer JR Jr, Scott DJ (2007) Psychomotor testing predicts rate of skill acquisition for proficiency-based laparoscopic skills training. Surgery 141(6):831–832CrossRefPubMed
31.
Stefanidis D, Korndorffer JR Jr, Markley S et al (2007) Closing the gap in operative performance between novices and experts: does harder mean better for laparoscopic simulator training? J Am Coll Surg 205(2):307–313CrossRefPubMed
32.
Stefanidis D, Korndorffer JR Jr, Sierra R et al (2005) Skill retention following proficiency-based laparoscopic simulator training. Surgery 138(2):165–170CrossRefPubMed
33.
Stefanidis D, Scerbo MW, Korndorffer JR Jr, Scott DJ (2007) Redefining simulator proficiency using automaticity theory. Am J Surg 193(4):502–506CrossRefPubMed
34.
Rehrig ST, Powers K, Jones DB (2008) Integrating simulation in surgery as a teaching tool and credentialing standard. J Gastrointest Surg 12(2):222–233CrossRefPubMed
35.
Avgerinos DV, Goodell KH, Waxberg S et al (2005) Comparison of the sensitivity of physical and virtual laparoscopic surgical training simulators to the user’s level of experience. Surg Endosc 19(9):1211–1215CrossRefPubMed
36.
Fried GM (2008) FLS Assessment of competency using simulated laparoscopic tasks. J Gastrointest Surg 12(2):210–212CrossRefPubMed
37.
Parker WH, Johns A, Hellige J (2007) Avoiding complications of laparoscopic surgery: lessons from cognitive science and crew resource management. J Minim Invasive Gynecol 14(3):379–388CrossRefPubMed
38.
Tsuda S, Scott D, Doyle J, Jones DB (2009) Surgical skills training and simulation. Curr Probl Surg 46(4):261–372
39.
Fried GM (2008) FLS assessment of competency using simulated laparoscopic tasks. J Gastrointest Surg 12(2):210–212CrossRefPubMed
40.
Holzman RS, Cooper JB, Gaba DM et al (1995) Anesthesia crisis resource management: real-life simulation training in operating room crises. J Clin Anesth 7(8):675–687CrossRefPubMed
41.
Blum RH, Raemer DB, Carroll JS et al (2004) Crisis resource management training for an anaesthesia faculty: a new approach to continuing education. Med Educ 38(1):45–55CrossRefPubMed
42.
Jenkins RC, Lemak CH (2007) Innovative teaching for health law: a case study of a hospital medical malpractice lawsuit simulation. J Health Adm Educ 24(1):43–57PubMed
43.
Raborn GW, Carter RM (1999) Using simulation to evaluate clinical competence after impairment. J Can Dent Assoc 65(7):384–386PubMed
44.
Berry W (2006) Surgical malpractice: myths and realities. J Med Pract Manage 22(1):50–51PubMed
45.
Regenbogen SE, Greenberg CC, Studdert DM et al (2007) Patterns of technical error among surgical malpractice claims: an analysis of strategies to prevent injury to surgical patients. Ann Surg 246(5):705–711CrossRefPubMed
46.
Dunkin B, Adrales GL, Apelgren K, Mellinger JD (2007) Surgical simulation: a current review. Surg Endosc 21(3):357–366CrossRefPubMed
47.
Singh H, Thomas EJ, Petersen LA, Studdert DM (2007) Medical errors involving trainees: a study of closed malpractice claims from 5 insurers. Arch Intern Med 167(19):2030–2036CrossRefPubMed
48.
Martin JA, Regehr G, Reznick R et al (1997) Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 84(2):273–278CrossRefPubMed
49.
Metadata
Title
Malpractice carrier underwrites Fundamentals of Laparoscopic Surgery training and testing: a benchmark for patient safety
Authors
Alexandre Y. Derevianko
Steven D. Schwaitzberg
Shawn Tsuda
Limaris Barrios
David C. Brooks
Mark P. Callery
David Fobert
Noel Irias
David W. Rattner
Daniel B. Jones
Publication date
01-03-2010
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 3/2010
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-009-0617-x

Other articles of this Issue 3/2010

Surgical Endoscopy 3/2010 Go to the issue

OriginalPaper

The inflammatory response in transgastric surgery: gastric content leak leads to localized inflammatory response and higher adhesive disease

Letter

Single-incision laparoscopic hernioplasty with the assistance of the Radius Surgical System

Letter--Reply

Reply to: doi:10.1007/s00464-009-0668-z: Combined laparoscopic–endoscopic resection of colorectal polyps: 10-year experience and follow-up evaluation

OriginalPaper

Endoscopic submucosal dissection for rectal carcinoid tumors

OriginalPaper

Cardiovascular responses to prolonged carbon dioxide pneumoperitoneum in neonatal versus adolescent pigs

Technique

A hybrid technique: video-assisted thoracoscopic surgery (VATS) pulmonary resections for community-based surgeons