Who Is GESEA Level 1 For?
GESEA Level 1 is the entry tier of the ESGE competency ladder — the Bachelor in Endoscopy — and it is designed for physicians who need a defined, assessed foundation in basic laparoscopy and hysteroscopy rather than a subspecialty credential. The programme page for the Ankara session lists four suitable backgrounds: obstetrics and gynaecology residents, specialists in obstetrics and gynaecology, physicians working in reproductive medicine or minimally invasive gynaecological surgery, and academic clinicians seeking a formal Basic Level skills pathway. In practice those headings describe four career situations with different reasons for arriving at the same session.
The first is the resident in clinical years who has assisted in the theatre and now wants a validated benchmark before taking the camera or the instruments independently. The second is the newly qualified specialist whose training was strong on case volume but never included a criterion-referenced skills test. The third is the experienced surgeon who already operates laparoscopically and wants that skill formalised on paper — often as the first rung towards Level 2. The fourth is the international graduate assembling a fellowship or observership application and looking for objective, portable evidence of psychomotor skill.
What unites them is that Level 1 measures foundations, not experience. Its four components — the TESTT theory examination and the LASTT, SUTT and HYSTT psychomotor stations — are each scored against defined benchmarks, the psychomotor stations for accuracy and economy of movement on standardised tasks. That makes the certificate legible across institutions and countries, which is why residents and international applicants find it useful, and why an experienced surgeon may reasonably weigh Level 1 against direct entry to Level 2.
- Residents in clinical years — a validated benchmark before independent laparoscopic operating.
- Newly qualified specialists — a criterion-referenced skills test that residency did not include.
- Experienced laparoscopic surgeons — formalising skills, or weighing direct entry to Level 2 instead.
- International graduates — objective, portable evidence for fellowship and observership applications.
When Is the Right Moment in Training to Take Level 1?
The right moment for Level 1 is the window after basic operating-theatre exposure and before independent laparoscopic operating. Taken too early — before a resident has held a laparoscope, handled ports or seen energy devices used in a real theatre — the e-learning and the stations lack context and the psychomotor tasks feel abstract. Taken too late — after years of unsupervised laparoscopy — the certificate documents what practice has already established, and an experienced surgeon may be better served by the Level 2 route described below.
For residents, that window usually falls in the middle to late clinical years, once camera-holding and assisting are routine and the first supervised procedures are in view. For specialists, it falls in the first years of independent practice, especially where residency did not include structured simulation. The practical preparation — the mandatory ESGE Academy e-learning and box-trainer hours — takes weeks rather than days, so booking should precede the session by a full preparation cycle.
There is a useful comparison in North America. The American Board of Obstetrics and Gynecology requires residents graduating from 2020 onward to document completion of a surgical-skills standard — the SAGES/ACS Fundamentals of Laparoscopic Surgery programme or the EMIGS alternative — before board certification. FLS is a general-surgery-derived assessment rather than a gynaecology-specific one, but the timing logic is the same: an objective skills test sits inside residency, before independent practice, not after it. GESEA Level 1 occupies that position in the European pathway, but whether it is required depends on the national training programme rather than on a single board, so the timing decision usually belongs to the trainee and their programme.
What Must Be Done Before a Level 1 Session?
The single non-negotiable prerequisite is the official ESGE Academy GESEA Level 1 e-learning, which every participant must complete before the session — including those on a training-only route who do not sit the certification examination. It is purchased separately and directly from the ESGE Academy; its fee is not part of the session fees, which are stated on the programme page. The TESTT theory examination draws on its content and the station briefings assume it, so arriving without it means arriving unprepared for both days.
The second prerequisite is unofficial but decisive: box-trainer hours, and the question for this article is when they start rather than what they contain. The LASTT, SUTT and HYSTT stations score accuracy and time on standardised tasks, so the practice block should begin as soon as the e-learning has explained what each station measures — typically several weeks before the session, and before the application deadline rather than after acceptance. The content of a useful routine is set out in the companion article on exam difficulty; the sequencing point here is that the e-learning comes first, timed runs come last, and an applicant who has done neither by the deadline is usually better placed on the training-only route than in a certification attempt.
The third step is administrative. For the Ankara session, applications are reviewed academically before any payment is requested; the programme office may ask for a CV and supporting professional information, and the aim is to align each applicant's current experience with the selected route. Applicants should therefore describe their role, training stage and endoscopic experience accurately rather than generously — the review is there to match experience to route.
What Does Level 1 Prove, and Which Route Fits Which Stage?
A GESEA Level 1 certificate proves that, on a given day, a physician met defined benchmarks in endoscopic theory (TESTT) and on three validated psychomotor stations (LASTT, SUTT and HYSTT). It is issued by ESGE, the certifying body of the GESEA programme, and certification is awarded only after successful completion of all four components. It does not prove operative competence in patients, it does not confer any licence or privilege, and whether an employer, board or national body gives it weight depends entirely on that institution.
The session in Ankara separates training from certification so that each physician can choose according to stage. The training-only route covers the two training days of theory and hands-on station practice and ends with a co-branded certificate of attendance — explicitly not the official GESEA Level 1 certificate. The certification-only route is for physicians who have already trained elsewhere and need one scheduled official attempt. The combined route joins two days of structured practice to the certification day. In every case the ESGE Academy e-learning is mandatory.
Reading the routes by career stage: a resident early in the window often benefits most from training only, returning for certification once practice has consolidated; a resident late in the window or a new specialist is usually ready for the combined route; a specialist who has already trained on validated stations can apply for certification only.
| Route | Typically suits | E-learning required | What it results in |
|---|---|---|---|
| Training only | Residents early in the window; anyone consolidating skills before an attempt | ESGE Academy Level 1 e-learning, mandatory | Co-branded certificate of attendance — not the GESEA certificate |
| Certification only | Physicians already trained on validated stations | ESGE Academy Level 1 e-learning, mandatory | One scheduled official GESEA Level 1 attempt |
| Training + certification | Residents late in the window; newly qualified specialists | ESGE Academy Level 1 e-learning, mandatory | Training plus one scheduled official Level 1 attempt |
| Direct entry to Level 2 | Experienced surgeons with documented operative experience | Level 2 e-learning, plus a signed institutional letter | Level 2 application assessed under GESEA rules |
Can an Experienced Surgeon Skip Level 1 and Enter Level 2 Directly?
Yes, under conditions set by the GESEA programme. Level 1 is not always required before Level 2: direct entry is possible for experienced surgeons and, as summarised on the programme page, it rests on two core elements; ESGE may attach further published conditions. The first is a signed letter from the physician's institution confirming relevant surgical experience — for example, the number of laparoscopic hysterectomies performed. The second is successful completion of the Level 2 e-learning module. Applications of this kind are assessed under the applicable GESEA rules, and Level 2 — the Minimally Invasive Gynaecological Surgeon level — then has a certification session of its own, with TESTT and the LASTT, SUTT and HYSTT stations at Level 2, before the MIGS diploma is earned through independently reviewed operative case videos.
The decision between Level 1 and direct entry is therefore a question of evidence. A surgeon whose institution will document substantial laparoscopic operative experience in writing, and who is prepared to submit unedited operative video for review, may be a direct-entry Level 2 candidate under GESEA rules. A surgeon whose experience is real but undocumented, uneven across laparoscopy and hysteroscopy, or accumulated in a setting that cannot issue such a letter, will usually find Level 1 the faster and more secure way to establish a formal foundation — and it remains the standard rung below Level 2 on a ladder that continues to Level 3, the Master level.
International graduates preparing fellowship or observership applications sit in an intermediate position. Their operative experience is often considerable but attested only by their home institution, and a host department abroad may value an ESGE-issued Level 1 certificate precisely because it is a standardised, third-party measure. For that group, Level 1 is less a step to be skipped than an objective document to be added to a file whose other contents are hard for a reviewer to verify.
What Is the Next Step, by Career Stage?
The practical sequence is the same whichever branch describes you: complete the official ESGE Academy Level 1 e-learning, accumulate box-trainer hours, and book the next officially approved Level 1 session — or, if your operative experience is documented, prepare the institutional letter and the Level 2 e-learning instead. The list below states the decision for each career stage.
The concrete example at the time of writing is the officially approved GESEA Level 1 certification session held in Ankara on 20–22 November 2026, organised by ATDERA with the local GESEA training centre and listed on the ESGE educational calendar. It is delivered in English for a cohort of up to 20 physicians; the first two days cover theory and hands-on LASTT, SUTT and HYSTT training, and the third day is the certification session. Applications are reviewed academically before any payment is requested and close on 5 November 2026; route choices, fees and the application form are on the programme page.
- Resident in clinical years: complete the e-learning now, start box-trainer practice, and apply for the combined route if supervised procedures are already in view — otherwise the training-only route, returning for certification later.
- Newly qualified specialist: complete the e-learning, rehearse timed runs on a trainer, and apply for the combined route to add the criterion-referenced benchmark that residency did not provide.
- Experienced laparoscopic surgeon: ask whether your institution will sign a letter documenting your operative experience; if yes, complete the Level 2 e-learning and apply directly to Level 2 under GESEA rules; if not, take Level 1 — certification only if you have already trained on validated stations.
- International graduate preparing a fellowship or observership file: complete the e-learning and apply for the combined route in an English-language session, so that the certificate can be added to the application as third-party evidence.