Fundamentals of Endoscopic Surgery cognitive examination: development and validity evidence

Surg Endosc. 2014 Feb;28(2):631-8. doi: 10.1007/s00464-013-3220-0. Epub 2013 Oct 8.


Background: Flexible endoscopy is an integral part of surgical care. Exposure to endoscopic procedures varies greatly in surgical training. The Society of American Gastrointestinal and Endoscopic Surgeons has developed the Fundamentals of Endoscopic Surgery (FES), which serves to teach and assess the fundamental knowledge and skills required to practice flexible endoscopy of the gastrointestinal tract. This report describes the validity evidence in the development of the FES cognitive examination.

Methods: Core areas in the practice of gastrointestinal endoscopy were identified through facilitated expert focus groups to establish validity evidence for the test content. Test items then were developed based on the content areas. Prospective enrollment of participants at various levels of training and experience was used for beta testing. Two FES cognitive test versions then were developed based on beta testing data. The Angoff and contrasting group methods were used to determine the passing score. Validity evidence was established through correlation of experience level with examination score.

Results: A total of 220 test items were developed in accordance with the defined test blueprint and formulated into two versions of 120 questions each. The versions were administered randomly to 363 participants. The correlation between test scores and training level was high (r = 0.69), with similar results noted for contrasting groups based on endoscopic rotation and endoscopic procedural experience. Items then were selected for two test forms of 75 items each, and a passing score was established.

Conclusions: The FES cognitive examination is the first test with validity evidence to assess the basic knowledge needed to perform flexible endoscopy. Combined with the hands-on skills examination, this assessment tool is a key component for FES certification.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Clinical Competence / standards*
  • Cognition / physiology*
  • Education, Medical, Continuing / methods*
  • Endoscopy, Gastrointestinal / education*
  • Humans
  • Prospective Studies
  • Reproducibility of Results
  • United States