The FES Test: Are We Ready?

The FES hands-on skills test is administered using a $100,000 computer-based simulator. Few of our trainees have practiced on this device. Our aim was to evaluate our GS residents' baseline endoscopic skills and eventually develop a simulation-based endoscopy curriculum and clarify performance-based assessment criteria.

General surgery residents' colonoscopy skills were assessed using a computer-based endoscopy simulator (CBES) during their biannual simulation-based OSCE-type assessments. Trainees were asked to reach the ileum in <5 minutes with minimal patient pain and complications. Module 1 (easy) was assigned to PGY 1-4 residents and module 5 (hard) to both PGY 4s and 5s. The colonoscope insertion length, % time with no pain, % time in "red out", and complications were recorded. Performance grading criteria were driven by literature review and expert opinion. Residents were assessed in the fall 2017; they were then given scoring criteria, a step-by-step instruction manual, and a voluntary hands-on session with the CBES. Residents repeated the same assessment in the spring 2018.

30 PGY-1s, 12 PGY-2s, 8 PGY-3s, 9 PGY-4s and 7 PGY-5s GS residents participated in the fall colonoscopy assessment. In module 1, 66% of PGY-4s, 50% of PGY-3s, 8% of PGY-2s and 0% of the PGY-1s intubated the ileum (p<0.05). In module 5, 30% of PGY 5 and 22% of PGY 4 residents completed the task (p<0.05). 15 PGY-1s, 5 PGY-2s, 1 PGY-3, 2 PGY-4s, and 1 PGY-5 participated in the voluntary hands-on session. All residents completing the fall assessment undertook the same task in the spring. In module 1, 89% of PGY-4s, 100% of the PGY-3s, 75% of PGY-2s and 70% of the PGY-1s completed the task. In module 5, 30% of PGY 5 and 34 % of PGY 4 residents completed the task. Residents who participated in the voluntary hands-on session (n= 24, 96% task completion) outperformed residents (n= 42, 64% task completion) that did not participate (p<0.05).

Most of our GS residents could not initially intubate the ileum using the CBES. Prior experience with the CBES was the only factor strongly correlated with successful task completion. A voluntary hands-on teaching session allowed 96% of participating trainees to subsequently achieve CBES task completion. Developing a formal simulation-based curriculum suggests we can better prepare surgical trainees for the FES exam.