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Fundamentals of Laparoscopic Surgery - FAQs For Residents

Learn more about FLS by watching this video.


FLS is a comprehensive web-based education module that includes a hands-on skills training component and assessment tool designed to teach the physiology, fundamental knowledge, and technical skills required in basic laparoscopic surgery. The goal is to provide residents, fellows, and practicing physicians an opportunity to learn the fundamentals of laparoscopic surgery in a consistent, scientifically accepted format; and to test cognitive, surgical decision-making, and technical skills, all with the goal of improving the quality of patient care.

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) is the non-profit organization that offers FLS. Fill out the order form to purchase the didactic access and a testing voucher. The cost per resident is currently $525 in 2019.

Requiring completion of FLS is part of a broader initiative by ABOG to incorporate simulation and standardize the knowledge and training completed by the OB GYN residents. It also establishes an additional objective measure that all U.S. obstetricians and gynecologists applying for primary specialty certification must meet. ABOG's goal is to assure OB GYN residents an opportunity to learn the fundamentals of laparoscopic surgery in a consistent, scientifically accepted format, and to test cognitive, surgical decision-making and technical skills, all with the goal of improving the quality of patient care.

FLS includes a multimedia presentation of didactic content and "watch and do" exercises that focus on manual skills training. The content is available in a web-based format accessed online.

The requirement was announced in January 2018. Physicians graduating from residency in the academic year (AY) 2020 and beyond must complete the FLS requirement. This requirement does not apply to any candidates who graduated in prior academic years.

Candidates must complete FLS by December 18, 2019 if applying for the 2020 ABOG Qualifying Examination (QE). Residents may apply for the QE regardless of where they are in their FLS certification process. Residents may apply for the QE without verification of FLS registration or completion of the FLS program. They can take FLS at any time during residency, but the ideal time may be during the second year as residents are gaining more exposure to laparoscopy.

Each year, the first date for application for the OB GYN QE is mid-September, and the final date (deadline) is mid-December. This means that residents should complete the FLS program no later than mid-December the calendar year prior to graduation.

FLS proof of completion should be supplied to ABOG in the form of the FLS certificate and emailed as a PDF to fls@abog.org. Save your certificate as a PDF and name the file as follows: ABOG ID_Last Name_FLS.  Example: 123456_Smith_FLS.pdf. Insert "FLS Certificate" in the email subject line.

Please go to the FLS website to sign up.

For residents in Accreditation Council for Graduate Medical Education (ACGME) accredited programs, FLS currently costs $525 (in 2019). This includes online access to the didactic sessions and one test voucher.

A test voucher is the "admittance ticket" needed to take the FLS exam. Each voucher has a unique identification number and can be redeemed one time only. All test vouchers, including retest vouchers, have an expiration date printed on the upper right-hand corner, and tests must be completed by this date. The test must be completed within 12 months of the voucher purchase. If the FLS test is not successfully completed, a "retest" voucher may be purchased for $125 (in 2019) within 18 months of the original exam date.

The exam includes two assessments: a computer-based multiple-choice cognitive assessment and a performance-based manual skills assessment consisting of five skills performed on the FLS Trainer Box. Those who successfully complete both components will have demonstrated the knowledge, judgement, and technical skills fundamental to the performance of basic laparoscopic surgery.

The manual skills assessment consists of the five simulation exercises reflecting skills uniquely required in laparoscopic surgery such as ambidexterity, depth perception, hand-eye coordination and controlled movement of instruments, and efficiency of movement. The task performance is scored on both efficiency (time) and precision (accuracy).

The cognitive assessment consists of multiple-choice questions, some of which include visuals and clinical scenarios. It is computer-based and designed to test the understanding and application of the fundamentals of laparoscopy with as much emphasis of possible on clinical judgement or intra-operative decision-making.

If you fail one or both parts of the assessment, you must retake whatever part was not completed successfully within 18 months of your original exam date, and there is currently a $125 fee (in 2019) to retest. If one or both are still not passed after the first retake, then the participant must wait six months for the next retake (again, this must occur withing 18 months or your original exam date). After three retakes, or 18 months, a new registration process is required, and both assessments must be undertaken anew, even if one had been passed previously.

The didactic portion of FLS can be completed online. To take the examination, you must go to an FLS testing center. There are 85 testing centers throughout the United States and Canada. Over 70% of the current ACGME-accredited OB GYN programs are within one hour of a testing center. Find the testing center nearest you.

You will have 90 minutes to complete the multiple-choice cognitive assessment. The manual skills assessment includes five designated skills administered on the FLS Trainer Box and lasts approximately 30-45 minutes. Both are administered by a trained FLS proctor.

To practice the skills needed for the FLS examination, you will need to use an FLS Trainer Box. These boxes are available in many residency programs and institutions that have simulation centers.

All general surgeons who desire to become certified by the American Board of Surgery are required to take FLS prior to taking their QE. If there is a general surgery residency program at your hospital, it is very likely that the program or institution has a trainer box. If there is not a trainer box at your institution, one can be purchased here. Other laparoscopic skills trainer boxes can be used to practice and for formative feedback in training, but you must use the FLS Trainer Box and proctored examination to meet the ABOG requirement.

Anyone is eligible to review the curriculum, but the FLS certification is limited to medical residents, fellows, and practicing general surgeons, obstetricians and gynecologists, urologists, surgical oncologists, and other physicians.

No, in order to meet the certification requirement, you must take and pass both parts of the FLS exam and receive the certificate.

Some scores will be mailed approximately three weeks after the testing date. For privacy reasons, scores will not be transmitted by telephone or facsimile. Those who successfully complete both the educational and assessment components will also receive a certification of completion confirming that they have demonstrated the knowledge, judgement, and technical skills fundamental to the performance of basic laparoscopic surgery.

All FLS certificates expire 10 years from the date of issue.

For any questions regarding OB GYN certification requirements, please email ABOG at exams@abog.org. For questions regarding the FLS curriculum or testing, please go to the FLS website or email fls@sages.org.