BIDMC surgeons to be tested on laparoscopic motor skills

Attending general surgeons at Beth Israel Deaconess Medical Center (BIDMC) will be required to prove basic motor skills outside an operating room before performing laparoscopic surgery on patients.

CRICO/RMF, the Harvard medical community's professional liability insurer, will offer “Fundamentals in Laparoscopic Surgery” (FLS) as a refresher course in January 2008. As an incentive for this voluntary program, CRICO/RMF is providing a one-time patient safety incentive to attending general surgeons who demonstrate successful completion of the FLS exam.

“We enthusiastically endorse the efforts of the general surgeons in their quest to improve and maintain their skills in laparoscopic surgery,” said Robert Hanscom, Vice President of Loss Prevention and Patient Safety. “We are grateful for the opportunity to fund this important effort for surgeons.”

In an unprecedented requirement, all BIDMC general surgeons will need FLS certification to obtain privileges in laparoscopy. This requirement for certification for privileging at BIDMC is the first time surgeons in the United States will be required to demonstrate motor skills, according to Daniel B. Jones, MD, FACS, BIDMC's Chief of Minimally Invasive Surgery.

Laparoscopy or ‘Band-aid surgery” distends the abdomen with carbon dioxide gas. Ports the diameter of a pencil have an air seal that permits long instruments to be inserted into the abdomen without losing air. The technique of several small cuts allows patients to experience less pain, shorter hospitalization and faster recovery.

Most surgeons who trained before 1990 had no formal training. Passing the FLS exam (www.fls.org) raises the bar by allowing the surgeon to show they have the skill to safely perform basic laparoscopic surgery.

“If we can ask bus drivers to pass an eye test, shouldn't you be able to ask your surgeon to pass a skills test?” said Jones. “This requirement simply puts all surgeons on the same footing as their colleagues in terms of their skills on such basic techniques as tying knots.”

Surgeons will be tested, using a trainer box, on their proficiency to suture, cut in a circle and move objects from one location to another. In addition, an online written exam ensures cognitive knowledge of laparoscopy. The Carl J Shapiro Simulation and Skills Center (www.bidmc.harvard.edu/sasc) serves as the regional FLS testing site for New England.

All surgeons who complete the course successfully will receive continuing medical education credits through the Society of American Gastrointestinal and Endoscopic Surgeons and the American College of Surgeons. The FLS Patient Safety Incentive Program has been made available to all attending general surgeons insured by CRICO. Details can be viewed at http://www.rmf.harvard.edu/fls.

“I know that the program provides participants with the basic skills they should have as laparoscopic surgeons,” said Jones. “When I did it myself, I found the course serves as a refresher on rare complications and events that I may not have seen but could see in the future.” Jones predicts that FLS will become a new minimal standard for all surgeons offering basic laparoscopy to patients.

Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School, and consistently ranks among the top four in National Institutes of Health funding among independent hospitals nationwide. BIDMC is clinically affiliated with the Joslin Diabetes Center and is a research partner of Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit www.bidmc.harvard.edu.