Structured Simulation Improves Learning of the Fundamental Use of Surgical Energy(tm) (FUSE) Curriculum: A Multicenter Randomized-Controlled Trial

Amin Madani, MD1, Yusuke Watanabe, MD1, Nicole Townsend, MD2, Thomas Robinson, MD2, Daniel Jones, MD3, Jaisa Olasky, MD3, Sharon Bachman, MD4, Chan Park, MD5, Philip Pucher, MD6, Patricia Egerszegi, MD7, David Tang, MD8, Nalin Amin, MD9, Erika Haase, MD10, Davide D Bardana, MD11, Gerald Fried, MD1, Liane Feldman, MD1. 1McGill University, 2University of Colorado – Denver, 3Beth Isreal Deaconess Medical Center, 4Inova Fairfax Hospital, 5Duke University, 6Imperial College London, 7Universite de Montreal, 8Dalhousie University, 9McMaster University, 10University of Alberta, 11Queen’s University


While energy devices are ubiquitous in the operating room, they remain poorly understood and can result in devastating complications. SAGES’ Fundamental Use of Surgical Energy™ (FUSE) program was created to address these knowledge and safety gaps. A single institution pilot study suggested that adding a goal-directed simulation to the FUSE curriculum improves surgical trainees’ knowledge of electrosurgery (ES). The purpose of this study was to estimate the extent to which the addition of this structured bench-top simulation improves ES knowledge across multiple surgical training programs.


First and second year surgical residents from 11 residency programs in Canada, US and UK 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). The one-hour goal-directed simulation session (Sim group) 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, drafted by 2 subject matter experts according to the FUSE curriculum test objectives and blueprint. Data are expressed as mean (SD) and % (N). Paired and unpaired t-test determined significance (p<0.05). Analysis of covariance was used to adjust post-curriculum scores for confounders, including demographics, pre-curriculum scores and student:teacher ratio.


Two-hundred and eighty-eight (145 control; 143 Sim) surgical trainees completed the curriculum (mean age 27; 57% male). Baseline characteristics, including pre-curriculum exam scores, were similar between the two groups. Total score on the exam improved from 46% (10) to 84% (10), p<0.01 for the entire cohort, with higher post-curriculum scores in the Sim group compared to controls (86% (9) vs 83% (10), p<0.01). This difference was due to better performance for the Sim group on the exam sections “Electrosurgery-Related Adverse Events” (84% (11) vs 80% (15), p<0.01) and “Interference with Implantable Medical Devices” (84% (23) vs 68% (27), p<0.01). Independent predictors of post-curriculum scores included pre-curriculum score (β 27.22, 95%CI 17.87 to 36.56, p<0.01), student:teacher ratio (β -0.27, 95%CI -0.57 to -0.04, p=0.02) and the presence of a goal-directed simulation (β 1.71, 95%CI 0.52 to 2.90, p<0.01). The majority of participants (93% (267)) either “Agree” or “Strongly Agree” that the surgical energy curriculum will change their attitude and practices when using energy-based devices, with a higher proportion in the Sim group “Strongly” agreeing compared to the control group (59% (84) vs 34% (50), p<0.01).


This multi-institutional study confirms that a two-hour curriculum based on the FUSE program improves surgical trainees’ knowledge in the safe use of ES devices throughout several training programs with various geographic locations and resident volumes. The addition of a structured interactive bench-top simulation component further improved learning.

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