Fundamentals of Laparoscopic Surgery (FLS) is a program consisting of a teaching curriculum and an exam developed by the Society of American Gastrointestinal and Endoscopic Surgeons.1 While it has been a component of general surgery training for over a decade, in 2020 the American Board of Obstetrics and Gynecology (ABOG) mandated FLS as a prerequisite exam for graduating OBGYN residents to board certification.2 However, validity evidence supporting the use of FLS as a high-stakes exam for both general surgery residents and Obstetrics and Gynecology (OBGYN) residency is insufficient.3,4 In addition, to the best of our knowledge, no commonly accepted and widely published conceptual training framework exists on how to pass FLS. Instructions provided on the FLS website list metrics chosen by FLS with the expectation that learners practice on their own to meet those metrics (Table 1).5 As a result, surgical educators create their own training programs and curricula for teaching FLS locally and nationally.6, 7, 8

There are many gaps in our knowledge of incorporating FLS into the gynecologic surgical curriculum. Challenges of transferability have been described in several studies of FLS in gynecology and general surgery.3,4 One of them is the utility of procedure-specific simulation, to address the issue of skill transferability. In a recent study, Leon et al. found that performance on FLS tasks created a cognitive bias or an “illusion of validity.”4 In his study, performance on FLS tasks did not adequately correlate with performance on cadaveric cuff closure, a skill specific to gynecologic laparoscopy, while performance on a simulated cuff closure did. Furthermore, those who were FLS-certified and reported meeting FLS standards performed worse on cuff suturing than those who were not FLS-certified.

In this study, we aim to determine the extent of correlation of performance by OBGYN residents preparing to take the FLS exam on simulated vaginal cuff closure with scores on the FLS manual task exam.