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

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.