Long-term Knowledge Retention Following Simulation-based Training for Electrosurgery: 1 Year Follow-up of a Randomized-controlled Trial

Amin Madani, MD1, Yusuke Watanabe, MD1, Melina C Vassiliou, MD1, Pascal Fuchshuber, MD2, Daniel B Jones, MD3, Steven D Schwaitzberg, MD4, Gerald M Fried, MD1, Liane S Feldman, MD1. 1McGill University, 2Kaiser Medical Center, 3Beth Israel Deaconess Medical Center, 4Cambridge Health Alliance

INTRODUCTION: Simulation can add significant educational value to surgical curricula. A single institution study suggested that adding a goal-directed hands-on simulation to SAGES’ Fundamental Use of Surgical Energy™ (FUSE) program improves surgical trainees’ knowledge of electrosurgery (ES) up to 3 months after training. However, it is unclear if this improvement persists long-term. The purpose of this study was to estimate the extent to which adding a goal-directed bench-top simulation to the FUSE curriculum improves knowledge of the safe use of ES amongst surgical trainees 1 year later.

METHODS AND PROCEDURES: As previously reported, surgical residents participated in a 1-hour didactic 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 hands-on training session (Sim group). Pre- and post-curriculum (immediate, 3 months and at 1 year) knowledge of the safe use of ES was assessed using a 35-item multiple-choice examinations. Data are expressed as % (N) and median [25th percentile; 75th percentile].

RESULTS: 56 (29 control; 27 Sim) surgical trainees participated. Drop-out rates were 26% (20) in the Sim group and 30% (20) in the control group (p=0.45) at 1 year. After an initial improvement of total score on the exam immediately after the curriculum (Figure 1), knowledge performance declined progressively in both groups, but remained higher in the Sim Group at 1 year (70%[61;74] vs 60%[31;71], p=0.02). Compared to baseline, total score after 1 year was significantly greater in the Sim group (70%[61;74] vs 49%[43;57], p<0.01), but similar in the control group (60%[31;71] vs 45%[34;52], p=0.25). At 1 year, the majority of participants (88% (35)) either “Agree” or “Strongly Agree” that the curriculum has changed their attitude and practices when using energy-based devices over the past 12 months, with a trend towards a higher proportion in the Sim group “Strongly” agreeing compared to the control group (30% (6) vs 10% (2), p=0.11).

CONCLUSION: A 2-hour FUSE-based curriculum improves surgical trainees’ long-term knowledge in the safe use of ES devices only when combined with a structured and interactive bench-top simulation. However, even with the use of simulation, retention of knowledge eventually declines after a single session despite ongoing clinical use of ES devices. This suggests the need for ongoing and deliberate educational activities to reinforce the safe use of surgical energy.

Figure 1: Total score (%) on the multiple-choice examination during pre-curriculum (PRE), immediate post-curriculum (POST), 3 months follow-up and 1 year follow-up periods.


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