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Fundamentals of Laparoscopic Surgery - FAQs For Residents

Watch this video to learn more about the FLS requirement.


What is FLS?

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.


Who offers FLS?

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) is the non-profit organization that offers FLS. Educational packages can be purchased on the FLS website at https://www.flsprogram.org/testing-information/test-packages/. A package includes study guides for three residents and three test vouchers for $1,575. The cost per resident is currently $525 in 2018.


Why is ABOG requiring obstetrics and gynecology (OB-GYN) residents to take FLS to be eligible for certification?

Requiring completion of FLS is part of a broader initiative by ABOG to incorporate simulation and standardize the knowledge and training completed by 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.


What do I learn from the FLS curriculum?

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


When does this requirement take effect?

The requirement was announced in January 2018. Physicians graduating from residency in the academic year (AY) 2020 and beyond must pass FLS before taking the QE. Anyone who graduates from residency after May 31, 2020 must complete FLS before applying for the examination.


When does a candidate have to take FLS?

Candidates must complete FLS before applying for the ABOG Qualifying Examination (QE). They will be instructed to supply a copy of the certificate of completion at the time of their application. 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 in mid-September, and the final date is at the end of December. This means that residents should complete FLS before the end of December the calendar year prior to their graduation. Graduates in the AY 2019-2020 will need to pass the FLS by December 2019.


How do I sign up for FLS?

Please go to www.flsprogram.org to sign up.


How much does FLS cost?

For residents in Accreditation Council for Graduate Medical Education (ACGME) accredited programs, FLS currently costs $525 (in 2018). This includes online access to the didactic sessions and one test voucher. The fee for 2019-2020 has not yet been determined.


What is a 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 “re-test” voucher may be purchased for $125 (in 2018 dollars) within 18 months of the original exam date.


What is on the FLS Exam?

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, judgment and technical skills fundamental to the performance of basic laparoscopic surgery.


What is covered in the FLS manual skills exam?

The manual skill 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).


What is the cognitive assessment?

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 as possible on clinical judgment or intra-operative decision-making.


Can I take the FLS exam again?

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 currently is a $125 fee (2018 dollars) 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 within 18 months of 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.


Where do I take FLS?

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 in Canada. Over 70% of the current ACGME-accredited OB GYN programs are within one hour of a testing center. To find the testing center nearest you, please go to https://www.flsprogram.org/testing-information/fls-test-centers/.


How much time will it take to complete the FLS Exam?

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


How do I practice the skills test for FLS?

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 in your institution, one can be purchased from http://www.fls-products.com. 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.


Who is eligible to take the FLS Exam?

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


My residency already requires training in FLS without requiring the examination. Will this meet the ABOG requirement for certification?

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


When will I receive my FLS exam scores?

Score reports 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, judgment and technical skills fundamental to the performance of basic laparoscopic surgery.


Does my FLS certificate expire?

All FLS certificates expire in ten years from the date of issue.


Where do I direct my questions regarding FLS?

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