Learning Curves of OBGYN Residents Preparing for the FLS Manual Skills Exam

Objective: To describe obstetrics and gynecology (OBGYN) resident practice patterns and learning curves as they prepare for the Fundamentals for Laparoscopic Surgery (FLS) manual skills exam and to assess the importance of meeting proficiency, based on published standards, for passing the FLS manual skills exam. Methods: This is a prospective observational study of OBGYN resident physicians from July 2018 to January 2022. Residents recorded details about their FLS practice sessions and proficiency metrics for each task repetition. Manual skills exam scores were then compared to task practice variables. Learning curves were developed from resident practice patterns. Results: Fifty OBGYN residents participated in the study. The median number of repetitions per FLS manual skills task ranged from 3.5 (interquartile range [IQR] 2-7) (Task 3) to 7.5 (IQR 3-14) (Task 1). The average number of hours spent practicing was 5.4 hours (SD 3.4 hours), with a median of 3.7 sessions with faculty and/or fellow guidance and 1 self-practice session. All residents passed the FLS manual skills exam. Only for Task 2 (95% confidence interval [CI] 0.24, 5.21) and for the total number of repetitions for all tasks (95% confidence interval [CI] 0.22, 3.74) was a greater number of practice repetitions associated with higher FLS manual skills exam scores. Notably, postgraduate year, number and type of practice sessions, and the number of hours were not associated with higher scores. For all tasks, learning curves showed the greatest rate of improvement in the first 10 to 15 repetitions before diminishing returns. Conclusion: Greater number of practice hours and sessions were not associated with better manual exam scores in a cohort of OBGYN residents with a high proportion of supervised practice sessions. Achieving more advanced proficiency at certain FLS tasks may allow for better performance on the exam.