The Impact of Simulation Based Training on the Fundamentals of Endoscopic Surgery Performance Examination

E. Matthew Ritter*, Yoon Soo Park, Steven J. Durning, Ara S. Tekian

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Objective: To determine if simulation training is required to pass the FES skills test and assess the relationship between simulation training, clinical training, and FES skills test performance. Summary of Background Data: The ABS began requiring completion of the Flexible Endoscopy Curriculum for all applicants beginning in 2018. The role of simulation-based training in FES skills test performance after this requirement has not been evaluated. Methods: De-identified data from the initial FES skills tests after the Flexible Endoscopy Curriculum requirement was reviewed, and 731 unique participants with reported simulation experience demographics were identified. Self-reported data included sex, upper (UE) and lower (LE) endoscopy experience, and simulator training hours (SE). Final FES skills exam scores and pass/fail designations for each participant were reported by the FES program staff. Results: There was a statistically discernible difference in mean FES total scores between those reporting no SE and more experienced groups (P = 0.002), and between less and more experienced UE and LE groups (P < 0.001). There was no statistically discernible difference in FES skills exam pass rates between SE groups (P = 0.2), but there was a strong relationship between clinical experience (UE & LE) and pass rate (P < 0.001). Finally, on logistic regression analysis, LE was a discernible predictor of passing [odds ratio (OR) = 1.4, 95% confidence interval (CI) 1.1-1.8, P = 0.02], while UE [odds ratio (OR) = 1, 95% CI 0.8-1.3, P = 0.9] and SE (OR = 1,95% CI 0.9- 1.3, P = 0.7) were not. Conclusions: There is no threat to the validity of the FES skills test from a need for simulation training to pass the FES skills test. Similarly, the amount of simulation practice is not predictive of passing, but can improve performance on certain FES tasks.

Original languageEnglish
Pages (from-to)E699-E706
JournalAnnals of surgery
Issue number3
StatePublished - 1 Mar 2023
Externally publishedYes


  • assessment
  • flexible endoscopy
  • fundamentals of endoscopic surgery
  • simulation


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