Surgical Endoscopy (2018) 32:3070–3075
Development of a train-to-proﬁciency curriculum for the technical
skills component of the fundamentals of endoscopic surgery exam
· Michael Marohn
· Saowanee Ngamruengphong
· Gina Adrales
· Oluwafemi Owodunni
· Emil Petrusa
· Pamela Lipsett
Received: 25 November 2017 / Accepted: 19 December 2017 / Published online: 8 January 2018
© Springer Science+Business Media, LLC, part of Springer Nature 2018
Background The demonstration of competency in endoscopy is required prior to obtaining American Board of Surgery
Certiﬁcation. To demonstrate competency, the resident must pass a national high-stakes cognitive test and a technical skills
exam on a virtual reality simulator. The purpose of this preliminary study was to design a proﬁciency-based endoscopy
simulation curriculum to meet this competency requirement.
Methods This is a mixed methods prospective cohort study at a single academic medical institution. Prior to taking the
national exam, surgery residents were required to participate in a skills lab and demonstrate proﬁciency on 10 simulation
tasks. Proﬁciency was based on time and percent of objects targeted/mucosa seen. Simulation practice time, number of task
repetitions to proﬁciency, and prior endoscopic experience were recorded. Resident’s self-reported conﬁdence scores in
endoscopic skills prior to and following simulation lab training were obtained.
Results From January 1, 2016 through August 1, 2017, 20 surgical residents (8 PGY2, 8 PGY3, 4 PGY4) completed both a
faculty-supervised endoscopy skills lab and independent learning with train-to-proﬁciency simulation tasks. Median overall
simulator time per resident was 306 min (IQR: 247–405 min). Median overall time to proﬁciency in all tasks was 235 min
(IQR: 208–283 min). The median time to proﬁciency decreased with increasing PGY status (r = 0.4, P = 0.05). There was no
correlation between prior real-time endoscopic experience and time to proﬁciency. Reported conﬁdence in endoscopic skills
increased signiﬁcantly from mean of 5.75 prior to 7.30 following the faculty-supervised endoscopy skills lab (P = 0.0002).
All 20 residents passed the national exam.
Conclusions In this preliminary study, a train-to-proﬁciency curriculum in endoscopy improved surgical resident’s conﬁdence
in their endoscopic skills and 100% of residents passed the FES technical skills test on their ﬁrst attempt. Our ﬁndings also
indicate that uniform proﬁciency was not achieved by real-time experience alone.
Keywords FES · Simulation · Proﬁciency-based training · Endoscopy
In 2018, demonstration of competency in surgical endoscopy
will be required in order to obtain American Board of Sur-
gery (ABS) Certiﬁcation. This is a new educational goal of
which the objectives have been outlined in the Fundamentals
and Other Interventional Techniques
This work was presented at the Surgery Education Week Meeting
April 18–22, 2017 in San Diego, CA.
* Susan Gearhart
Department of Surgery, Johns Hopkins Medical Institutions,
Baltimore, MD 21286, USA
Department of Gastroenterology, Johns Hopkins Medical
Institutions, Baltimore, MD 21286, USA
The Center for Innovation in Graduate Biomedical
Education, Johns Hopkins University, Baltimore, MD 21286,
Department of Surgery, MGH Learning Lab, Massachusetts
General Hospital, Boston, MA 02114, USA
Johns Hopkins Bayview Medical Center, 4940 Eastern
Avenue, Baltimore, MD 21224, USA