A Madani, MD, Y Watanabe, MD, Mc Vassiliou, MD, P Fuchshuber, MD, Db Jones, MD, S Schwaitzberg, MD, Gm Fried, MD, Ls Feldman, MD. McGill University, Montreal, Canada; Kaiser Medical Center, Walnut Creek, CA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA; Cambridge Health Alliance, Cambridge, MA, USA.
INTRODUCTION: While energy devices are ubiquitous in the operating room, they remain poorly understood and can result in significant complications. The Fundamental Use of Surgical Energy™ (FUSE) program was created to address this safety gap. The purpose of this study was to investigate, in surgical trainees, the effectiveness of the FUSE curriculum for electrosurgical training and estimate the extent to which the addition of a novel simulation-based component improves educational outcomes.
METHODS AND PROCEDURES: First and second year surgical residents participated in a 1-hour didactic electrosurgery (ES) course, based on the FUSE curriculum. They were then randomized to one of two groups: an unstructured hands-on session where trainees used ES devices (control group) or a goal-directed simulation training session (Sim group). The one-hour simulation session included four bench-top modules designed to teach the safe use of ES devices. Pre- and post-curriculum knowledge of the safe use of ES was assessed using separate 35-item multiple-choice examinations. Self-perceived competence with each course objective and comfort with the performance of 7 tasks related to the safe use of ES were measured using Likert scale questionnaires. Data are expressed as median (interquartile range). Mann-Whitney-U test determined significance (p<0.05). Institutional ethics approval was obtained.
RESULTS: Fifty-six (29 control; 27 Sim) surgical trainees completed the curriculum (median age 27; 64% male). Baseline characteristics, including pre-curriculum exam and questionnaire scores, were similar between the two groups. Total score on the exam improved from 46% (40-54%) to 84% (77-91%), p<0.0001 for the entire cohort, with higher post-curriculum scores in the Sim group compared to controls (89% (83-94%) vs 83% (71-86%), p=0.02). This difference was due to better performance for the Sim group on the exam sections “Principles of Electrosurgery” (91% (86-100%) vs 82% (73-91%), p=0.004) and “Electrosurgery-Related Adverse Events” (86% (82-93%) vs 71% (64-86%), p<0.0001). On the pre-curriculum questionnaires, participants in both groups reported feeling “Uncomfortable” for all 7 tasks or “Not Competent” with most of the 35 course objectives (Sim: 33/35 objectives; control: 31/35 objectives). Post-curriculum, the majority of participants felt either “Comfortable” or “Very Comfortable” for all 7 tasks, and either “Partially Competent” or “Fully Competent” for all 35 objectives. A higher proportion of the Sim group felt “Very Comfortable” or “Fully Competent” (Sim: 3/7 tasks and 28/35 objectives; control: 0/7 tasks and 10/35 objectives).
CONCLUSION: A two-hour curriculum based on the FUSE program improved surgical trainees’ knowledge and comfort in the safe use of electrosurgical devices. The addition of a structured interactive bench-top simulation curriculum further improved learning.