Fundamental Use of Surgical Energy (FUSE) Certification: Validation and Predictors of Success

Thomas N Robinson¹, J Olasky², P Young³, L S Feldman⁴, P R Fuchshuber⁵, S B Jones², A Madani⁴, Michael Brunt⁶, D Mikami⁷, G P Jackson⁸, J Mischna⁹, S Schwaitzberg², Daniel B Jones². ¹University of Colorado, ²Harvard University, ³Kryterion, Inc., ⁴McGill University, ⁵Kaiser Pemanente, ⁶Washington University, ⁷Ohio State University, ⁸Vanderbilt University, ⁹SAGES

Introduction: The Fundamental Use of Surgical Energy (FUSE) program includes a web-based didactic curriculum and a high-stakes multiple choice question examination with the goal to provide certification of knowledge on the safe use of surgical energy-based devices. The purpose of this study was (1) to set a passing score through a psychometrically sound process, and (2) to determine what pre-test factors predicted passing the FUSE examination.

Methods: Beta-testing of multiple choice questions on 62 topics of importance to the safe use of surgical energy-based devices was performed. Eligible test-takers were physicians with a minimum of one year of surgical training who were recruited by FUSE task force members. Two forms of the FUSE multiple choice exam were beta-tested, each measuring 62 test objectives identified as important to the safe use of surgical energy-based devices. A pre-test survey collected information on years of practice, extent of pre-test studying and self-reported knowledge of surgical energy-based devices. Psychometric validity of the examination and passing score were determined using the modified Angoff method. Pre-test characteristics were examined using ANOVA, Pearson correlation and logistic regression to determine which characteristics were associated with a passing score.

Results: 227 individuals completed the FUSE beta-test and 208 completed the pre-test survey. The passing/cut score for the first test form of the FUSE multiple choice exam was determined using the Modified Angoff methodology and for the second test form was determined using a linear equating methodology. The overall passing rate across the two exam forms was 81.5%. Self-reported time studying the FUSE web-based curriculum for a minimum of >2 hours was associated with a passing examination score (p<0.001). Performance was not different based on increased years of surgical practice (p=0.363), self-reported expertise on one or more types of energy-based devices (p=0.683), participation in the FUSE post-graduate course (p=0.426), or having reviewed the FUSE manual (p=0.428). Logistic regression found that studying the FUSE didactics for >2 hours predicted a passing score (OR 3.61; 95% CI:1.44-9.05; p=0.006) independent of years in practice, attending a FUSE post-graduate course, reviewing the FUSE manual, or self-reported expertise on monopolar instruments.

Conclusion(s): The development of the FUSE examination, including the passing score, followed a psychometrically sound process. Self-reported time studying the FUSE curriculum predicted a passing score independent of other pre-test characteristics such as years in practice and self-reported expertise. The FUSE program, including didactic curriculum and assessment examination, enable certification of knowledge on the safe use of surgical energy-based devices.