Rationale for the Fundamental Use of Surgical Energy(tm) (fuse) Educational Program

Liane S Feldman, MD, Pascal Fuchshuber, MD, PhD, Daniel B Jones, MD, Jessica Mischna, BA, Malcolm G Munro, MD, Steven Schwaitzberg, MD, Fuse Task Force

McGill University, The Permanente Medical Group,Harvard Medical School, SAGES, UCLA, Cambridge Health Alliance

Introduction: Energy devices are ubiquitous in modern operating rooms. The combination of electrical current, heat generation, the wide variety of devices and the complex environments in which they are used can result in complications such as fire or iatrogenic thermal injuries. There is no standard curriculum or assessment for energy-based devices most surgeons are not adequately trained to prevent these problems. The Fundamental Use of Surgical Energy™ (FUSE) program will include a curriculum and certification examination to address this safety issue. The aim of this study was determine the self-perceived knowledge level of practicing surgeons related to energy devices and safe practices and identify areas to emphasize for the assessment component of the program.

Methods: In the context of developing a valid assessment tool, psychometricians led 15 content experts in a systematic process to define the knowledge and skills (competencies) required to use energy devices safely. These were categorized into 10 sections, each including 2 to 20 objectives (total 63). A survey was sent to 102 SAGES leader (Board, FUSE task force, Quality, Outcomes and Safety Committee) and selected members of the AORN and AAGL. Participants were asked to weight the relative importance of the 10 sections. In addition, they rated each objective for frequency, relevance and importance on a seven-point scale. These ratings were averaged to yield a single number from 1 to 7 for each objective. The survey also included five demographic and self-assessment questions.

Results: 50 people responded to the survey. Only 28% considered themselves “expert” in their knowledge of energy-based devices, while 60% were “somewhat knowledgeable”. 84% had used an energy-based device in addition to electrosurgery in the preceding three months. The most common source of knowledge for these practitioners was “industry sales representative or course” (42%). The highest-rated objectives (>6 out of 7) for the FUSE program included “Identify various mechanisms whereby electrosurgical injuries may occur”, “Identify general patient protection measures for setup and settings for the electrosurgical unit” and “Identify circumstances, mechanisms, and prevention of dispersive electrodes-related injury”. The highest weighted section was “Prevention of Adverse Events with Electrosurgery”, followed by “Fundamentals of Electrosurgery” and “Integration of Energy Systems with Other Medical Devices”.

Conclusion: Although basic and advanced energy-based devices are commonly used, training has come through industry representatives or industry-sponsored courses and few surgeons consider themselves experts. Competencies that emphasize electrosurgical safety and the integration of energy systems with other devices were viewed as most important for the FUSE assessment.

Session: Podium Presentation

Program Number: S107