Maryam Wagner¹
Carlos Gomez-Garibello², Allan Okrainec³, Neal Seymour⁴ and Melina Vassiliou¹
1 McGill University
2 Institute of Health Sciences Education - McGill University
3 University of Toronto
4 UMass Chan Medical School – Baystate

The Fundamentals of Laparoscopic Surgery (FLS) program is a training and assessment program created to meet the need for the safe introduction of minimally invasive techniques into the clinical environment. Since its launch 15 years ago, over 10,000 candidates have completed the program across 30 countries. However, the developments in the field of laparoscopic surgery have demanded an examination of the program to meet the needs of today’s surgical residents. This paper summarizes the process and key findings of a validation study used to examine FLS uses and interpretations, and the central framework that was developed to inform the development of an updated program. 

An argument-based validity approach1 was used to examine the ways in which FLS is used, and its test outcomes are interpreted. The study yielded six validity claims about the contributions of FLS to education and assessment. Through this process we recognized the need to define the construct of laparoscopic surgery to serve as a ‘framework of reference’ to evaluate the current FLS program (and associated validity claims). This framework was developed through: a literature review, and multiple retreats with subject-matter experts. 

The framework was articulated through a series of 10 entrustable professional activities2 (EPAs) and associated competencies defining the knowledge, skills and attitudes associated with performing laparoscopic surgery at a fundamental level. 

The robust validation study established the need for developing a framework of reference. This EPA-based framework provides: a systematic and meaningful approach to synthesizing numerous competencies; and a framework to create articulated curriculum initiatives, relevant instruction opportunities and trustworthy methods of assessment. 

This paper exemplifies an argument-based validation process to provide actionable guidance to health science education researchers also conducting validation work. Further, it illustrates methods for developing an EPA-based theoretical framework. 

References (maximum three) 

1. Kane MT (1992). An argument-based approach to validity. Psychological Bulletin 112, 527–535. 

2. ten Cate O. Entrustability of professional activities and competency-bases training. Medical education. 2005;39:1176-7.