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

Surg Endosc. 2010 Mar;24(3):616-23. doi: 10.1007/s00464-009-0617-x. Epub 2009 Aug 18.


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.

MeSH terms

  • Clinical Competence*
  • Competency-Based Education
  • Curriculum
  • Education, Medical, Continuing*
  • Education, Medical, Graduate*
  • Educational Measurement
  • Humans
  • Insurance Carriers / economics
  • Insurance, Liability / economics
  • Laparoscopy / standards*
  • Malpractice / economics
  • Risk Management
  • Surveys and Questionnaires