FLS testing

[SLUser11]

I am registered to take the FLS (Fundamentals of Laparoscopic Surgery) test at the ACS meeting in a couple weeks. Apparently there are separate cognitive and manual skills tests to be done.

For people who have taken this test already, how much time should I set aside for preparation? I'm relatively strapped for time right now, but I don't want to go in there cold turkey. Are there any resources that have practice questions or anything like that? Does anybody know what the passing score % is?

Any info on how to prepare and take this test would be appreciated. I'm starting the online tutorial now, and it seems painful and time consuming.

Thanks.

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[traumachick]

We had to take it last year (as 4's). The online prep IS painful, but I just read through it once and was fine taking the written test. 2 people who took it with me never got through the online stuff and failed it...it's stuff you sort of just have to read to know (IMO). The practical part, my department set up a simulator exactly like the one they would give us for the test and gave us a description of each of the testing stations (intracorporeal tying, endoloop, pegs, cutting a circle...maybe one more). They weren't bad, but again you had to have practiced and read to know exactly what they wanted....on one of the instruction sheets it tells you how many times or how long you should practice each skill for to be proficient and they were fairly accurate -- I think I used the simulator once a few weeks before the test for about 30 minutes and once a day or so before for about an hour and then practiced a few times right before the real thing, and it was fine.

HTH!

 

[glade]

Are you saying you weren't even given any preparation on the manual skills by your program? Because I thought that since it was mandatory to pass, every program got box trainers. Either way, the manual skill part is pretty basic, assuming you can do basic laparoscopic surgery (that's based on running through the box trainers, not on taking the testing).

 

[glade]

2 people who took it with me never got through the online stuff and failed it...it's stuff you sort of just have to read to know (IMO).

Yeah, I heard that it's actually the written part that will get you.

 

[traumachick]

it is basic, but we were told they wanted things a certain way...for example, for the intracorporeal tying you have to make the loops a certain way, etc. OH, extracorporeal know tying with a knot pusher was the other skill (pretty stupid)

 

[ESU_MD]

I didnt have to take the exam so I cant comment directly, but...

last year at the ACS, one of my junior colleagues was all worried to have to take the test in the next mornining. I took him out the night before and got this guy so liquored up that I am suprised he woke up the next morning and somehow he passed. I am quite sure he was still clinically drunk at the time of the exam.

so the moral of the story- as long as you arent a complete idiot and have 10 thumbs you will pass.

 

[opr8n]

the box skills are pretty basic for a senior level resident with any decent level of lap skills, most difficult is the intracorporeal knot b/c of the switching the hands thing which i never do in real life, but its ok.

The hard part od the test is the written. Some of the questions, I was just like, WHAT are they asking? After it was over, i though i failed, but then got my score back and got like 85% on the written, so passed. Learning point, you know ths crap, go with your gut

 

[JackADeli]

...For people who have taken this test already, how much time should I set aside for preparation? I'm relatively strapped for time right now, but I don't want to go in there cold turkey. Are there any resources that have practice questions or anything like that?...

Your program really should provide you some information. Also, you can get some information on the SAGES webpage I believe. My program gave me a disk with practice materials for the written. We had a sim lab to practice the practical portion too. I took it and passed written and practical parts. You can pass.

I just want to put in here that you shouldn't blow this off. All the stories about half drunk and passing and stuff do a disservice. I heard similar tales of...."if you did well in residency you shouldn't have any trouble on the boards, your at a great program". Well, I passed the boards but 20-30% do not pass. Take it seriously. The board takes FLS seriously and is updating and modifying it regularly. I am sure some folks have failed this. The fact that it is so passable and then one fails is very sad if not pathetic. You don't have to dedicate hundreds of hours to preparation. But, you should do the practice questions... so you know in advance that you know the material. And, you should practice the practical skills so you know in advance that you will complete the tasks within standard and pass. There should be no doubt or anxiety about if you passed or not. It is a little hurdle but very easy to overcome with a reasonable attention and preparation. It would be real sad to trip on a twig.

 

[SLUser11]

the box skills are pretty basic for a senior level resident with any decent level of lap skills, most difficult is the intracorporeal knot b/c of the switching the hands thing which i never do in real life, but its ok.

The hard part od the test is the written. Some of the questions, I was just like, WHAT are they asking? After it was over, i though i failed, but then got my score back and got like 85% on the written, so passed. Learning point, you know ths crap, go with your gut

I practiced in our sim lab for about an hour today. I've never done the switching hand technique either, but honestly once I got used to it, I could see its utility.

I looked briefly at the tutorial again. The 5 tasks don't seem too intimidating (transfer of pegs, cutting out a circle, endoloop application, stitching with extracorporeal tying, stitching with intracorporeal tying). The written exam is more intimidating to me because I'm sure they're looking for specific answers that may not seem obvious.

There are some practice questions within the tutorial (3-5 after each major section). Are there any other resources with practice questions? I didn't see any on the SAGES website.

 

[dpmd]

I took the test last year (as a 3 and knowing that my laparoscopic skills are weak-at least to me). I was post call, but since they brought a tester in from another city for us to do it at our program they wanted all of us to participate. The written test is not hard, but not all the answers are intuitive. However, if you actually go through the tutorial once everything they ask comes directly from it. I admit I raced through mine because I was doing it while I was night float and my attention may have wandered but every once in a while something would pop up on screen and I would say "really, I didn't know that". I made a effort to remember those things, which came in handy on the day to the exam.

The skills are not hard once you practice (either the actual skills or the real life version). I had never cut a circle before I started practicing, and I'm sure if I hadn't practiced I would have failed. They actually count the boxes to see how far off you are and over a certain amount is a failure even if you complete it under the time limit. I was so tired and wanted to get out of there I did it really fast. The tester said it was the fastest she had seen it done. It wasn't perfect of course, but it was close enough to pass. There are little things like that for the knots too. They inspect them and they have to be good enough or you will fail. The endoloop was almost my undoing because the equipment they had was different from what I was used to and I screwed it up with the knot pusher. She gave me a do over (something which I bet isn't strictly allowed, but since they allow you to practice once before you actually test and I didn't-again because I was tired and wanted to just get out of there-I think she figured it was ok) and I did fine.

Everyone in my program passed but it was only the 3's and up that took it. I think the moral of the story is don't stress too hard, but don't blow it off either.

 

[SLUser11]

The written test is not hard, but not all the answers are intuitive. However, if you actually go through the tutorial once everything they ask comes directly from it.

I'm trying to finish the online tutorial now and it is extremely painful. And yet, I feel compelled to finish it so I don't bomb the written test.

While the tutorial is already painful, I'm on a slow wireless hotel connection currently, so each video is taking 1-2 minutes to load......

 

[SLUser11]

I'm trying to finish the online tutorial now and it is extremely painful. And yet, I feel compelled to finish it so I don't bomb the written test.

While the tutorial is already painful, I'm on a slow wireless hotel connection currently, so each video is taking 1-2 minutes to load......

I took the test today, and thought the practical portion was pretty easy. The written portion, however, was very frustrating, as often there were 0-3 answers that could be right....plus, you can't go back and review/change your answers, which is annoying since towards the end of the test some of the earlier questions made more sense.

Overall, they say 90% of people pass the test on their first attempt, although the tester said that the vast majority still walk out of there thinking they failed.

I don't have any specific advice beyond doing the tutorial. Also, be proficient with several different laparoscopic instruments. The needle drivers and knot pushers were all new to me, but I was able to wing it.

 

[TypeADissection]

Couple of thoughts seeing as how I recently just took and passed this exam.

1. Written: You have 90 minutes for 80 MCQs (I think. I actually can't remember how many questions there were, but it was a lot more than I anticipated going in.) I think about half came from the online modules in some shape or form and the other half was stuff that you've come across from just being a resident. As mentioned in above posts, some of the questions don't have a single best answer and so I just chose one and moved on. If there was going to be a section that would've failed me, it was going to be this one. Thankfully I well passed. Watch the modules. Watch the modules. Watch the modules.

2. Practical: If your program has a sim lab, then you should be more than prepared for this section. Nothing will surprise you except maybe the instruments if you're really used to using a certain kind. They send it all back in a plastic bag to wherever the HQ is to evaluate your knots, how far you cut from the circle, etc. I practiced a lot going into this and was rewarded in return. I personally found it more helpful and enjoyable to practice over a cup of coffee with a colleague. We would do 30 minutes here and there and I was able to see how he would approach something and adapt accordingly.

Final thoughts: As my attending says in regards to the boards, "Easy to fail but not hard to pass." FLS isn't hard to pass but if you're not prepared, it can trip you up. Sorry to revive a long dead post but hopefully this can help someone who is getting ready to take this. Cheers.

 

[jjwoo]

My video "Laparoscopic Intracorporeal Suturing: Fundamentals With Tips & Tricks For New Learners" ( ) may help with techniques for intracorproeal knot trying.

Medical Students and Residents will be encouraged to use this video to learn laparoscopic intracorporeal knot tying. This is a challenging skill to learn, but once mastered, most other laparoscopic task come with ease.


The outline of the video is as follows:

• Introduction

• Needle Anatomy

• Needle Entrance (proper loading and back-loading)

• Needle Handling (Swiveling)

• Needle Loading

• Throwing a Stitch

• Knot-Tying (2 techniques, drop needle and hold needle)

• Tips and Tricks/Key Points


Good Luck All!!