The Fundamentals of Endoscopic Surgery (FES) skills test: factors associated with first-attempt scores and pass rate



The Fundamentals of Endoscopic Surgery (FES) program became required for American Board of Surgery certification as part of the Flexible Endoscopy Curriculum (FEC) for residents graduating in 2018. This study expands prior psychometric investigation of the FES skills test.


We analyzed de-identified first-attempt skills test scores and self-reported demographic characteristics of 2023 general surgery residents who were required to pass FES.


The overall pass rate was 83%. “Loop Reduction” was the most difficult sub-task. Subtasks related to one another only modestly (Spearman’s ρ ranging from 0.11 to 0.42; coefficient α = .55). Both upper and lower endoscopic procedural experience had modest positive association with scores (ρ = 0.14 and 0.15) and passing. Examinees who tested on the GI Mentor Express simulator had lower total scores and a lower pass rate than those tested on the GI Mentor II (pass rates = 73% vs. 85%). Removing an Express-specific scoring rule that had been applied eliminated these differences.

Gender, glove size, and height were closely related. Women scored lower than men (408- vs. 489-point averages) and had a lower first-attempt pass rate (71% vs. 92%). Glove size correlated positively with score (ρ = 0.31) and pass rate. Finally, height correlated positively with score (r = 0.27) and pass rate. Statistically controlling for glove size and height did not eliminate gender differences, with men still having 3.2 times greater odds of passing.


FES skills test scores show both consistencies with the assessment’s validity argument and several remarkable findings. Subtasks reflect distinct skills, so passing standards should perhaps be set for each subtask. The Express simulator-specific scoring penalty should be removed. Differences seen by gender are concerning. We argue those differences do not reflect measurement bias, but rather highlight equity concerns in surgical technology, training, and practice.

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We would like to gratefully acknowledge Jessica Mischna, Sarah Colon, Christelle Menetrier, and Vanessa Pryor from the SAGES Fundamentals Program for their help in providing the de-identified data.

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Correspondence to Matthew Lineberry.

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Sara Hennessy, M.D. is a Member of the FES Committee in SAGES. E. Matthew Ritter, M.D. serves on the Board of Governors of SAGES and is a Member of the FES Committee. Dr. Ritter receives royalties and research support from the Henry M. Jackson Foundation for the Advancement of Military Medicine related to the development and sale of a flexible endoscopy simulator that is in no way related to FES. Matthew Lineberry Ph.D. and Yoon Soo Park Ph.D. have no conflicts of interest or financial ties to disclose.

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Lineberry, M., Park, Y.S., Hennessy, S.A. et al. The Fundamentals of Endoscopic Surgery (FES) skills test: factors associated with first-attempt scores and pass rate. Surg Endosc 34, 3633–3643 (2020).

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  • Assessment
  • Gender
  • Psychomotor
  • Simulation
  • Surgery
  • Validity