Ally Ha, MD, Erik Criman, MD, Carly Richards, MD, Robert B Lim, MD. Tripler Army Medical Center
OBJECTIVE: While the use of surgical energy is ubiquitous in modern operating rooms, its safe use is not part of routine surgical training. Injuries and complications from electrical devices can be devastatingly severe, yet there is no current established standard method for educating physicians on the safe use of energy-based devices. The Society of American Gastrointestinal and Endoscopic Surgeons' (SAGES) Fundamental Use of Surgical EnergyTM (FUSE) program was developed to fill that educational and training void. It includes a web-based curriculum and certifications examinations and has been validated at civilian medical centers. The FUSE program has not been previously implemented or validated at a military medical center. We aim to evaluate the level of knowledge on the safe use of surgical energy among surgical staff and trainees from 7 surgical specialities in a Department of Defense (DOD) Military Treatment Facility (MTF).
METHODS: Staff surgeons and surgical trainees from all 7 surgical specialties (General Surgery, Cardiothoracic Surgery, Vascular Surgery, Obstetrics/Gynecology, Orthopedic Surgery, Urology, Otorhinolaryngology) in a DOD MTF were tested. Testing included an evaluation regarding their experiences with adverse events secondary to the unsafe use of surgical energy and a 15 multiple-choice examination to evaluate their knowledge on surgical energy. Multivariable logistic regression was used to estimate odds ratios adjusted for potential confounders such as trainee versus staff status, number of surgical cases/experience, previous instruction on surgical energy use, and surgical specialty.
RESULTS: A total of 140 pre-curriculum surveys were sent out, of which 50 responses (35.7%) were completed. Responses were grouped by experience as follows: department chiefs, staff surgeons, and surgical trainees. 32.1% of the respondents were General Surgery staff surgeons or trainees, while the departments of Obstetrics/Gynecology and Orthopedic Surgery comprised 16.1% and 14.3% of respondents, respectively. Department chiefs and staff surgeons comprised 48% of respondents. 45.8% of respondents denied any previous instruction in the use of surgical energy. 89.8% of respondents responded that they have personally set up the surgical energy equipment. Of the 50 respondents, 26 (52.0%) have personally witnessed a complication of surgical energy application, with the major common complication being skin or soft tissue burns, followed by solid organ/organ space burns. 6/9 (66.7%) of department chiefs completed the survey with an average score of 62.2% and median score of 60%. 19/62 (30.6%) of staff surgeons completed the survey with an average score of 49% and median score of 53%. 26/69 (37.7%) of surgical trainees completed the survey with an average score of 47.8% and median score of 53%.
CONCLUSIONS: This study demonstrated that suboptimal knowledge in the safe use of surgical energy is a universal weakness for the majority of surgical staff and trainees regardless of subspecialty or practical experience with the equipment. There is a widespread lack of formal training on the safe application of surgical energy, though complications are frequently encountered in the operating room, which suggests the need to improve surgical education at military medical centers for the purpose of raising literacy in this field.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 81092
Program Number: MSSP03
Presentation Session: Military Poster (Non CME)
Presentation Type: MSSPoster