The next time you sit in an airplane you might spend a moment thinking about how the flight crew incorporates the new technology that is added to the aircraft from time to time. Certainly the advent of GPS occurred in the midst of the careers of many senior pilots as well as the evolution of more sophisticated instrument landing systems. As a passenger you have the general expectation that the pilots were trained on these new systems long before you walked into the cabin that day. As a pilot, each time I planned to fly a new aircraft I was required to take a check ride with a flight instructor in order to be certain I was able to manage the systems in the aircraft, such as the new GPS, in order to avoid a potential fatality – mine. Is certainly been said many times in the aviation industry that the lessons pilots learn are too often written in their own blood. As surgeons, that’s not quite true for us, (think about whose blood) but that shouldn’t change our commitment to be the masters of all the new technology that enters into the operating room. I suppose I’m dating myself when I confess that I finished my training prior to the advent of the ultrasonic dissector, argon beam, and sophisticated radio frequency coagulators. It was mostly the good ole Bovie in my training days. New energy devices that came along in the 1990s such as ultrasonic dissectors clearly enabled us to do more advanced minimally invasive surgical procedures than ever before. Even recent graduates are confronted with new devices that deliver significant energy to tissue on a frequent basis. In your own practice, how did you learn to use the latest tool that you added to your energy armamentarium? Do you even know generally how it works? Can you assemble it? Could you (or your circulating nurse) successfully troubleshoot a malfunction? Do you know your responsibilities if it malfunctions? The answers to these questions are often disappointing from a patient safety point of view. I found this troubling and initiated a series of discussions within the SAGES Executive Committee and the SAGES Board of Governors hoping to persuade my colleagues that in the footsteps of FLS and FES, our third fundamentals program could be born. Like all new ideas that promote potential change a variety of responses were encountered. Some were wildly enthusiastic while others questioned the need to devote financial resources and a lot of human surgeon volunteer capital for such a curriculum. After all “we are the experts aren’t we?” But not unlike the new word you learn that you start to see it everywhere, the realization that there is a legitimate need for this curriculum began to emerge. Just in the last two months I have become aware of 4 recent OR fires. Still unconvinced? Check out https://www.outpatientsurgery.net/search/?sQ=fire.
Our past president, Jo Buyske, appointed Dan Jones to head the newly created task force charged with developing the curriculum and validated assessment methodology in the area of surgical energy. True to form Dan immediately went to work on the first order of business – the project needed a name. Blessed with a true inspiration, the FUSE project was launched. Pascal Fuchshuber and Liane Feldman were named co-chairs and the team went to work developing the FUSE taskforce. The Fundamental Use of Surgical Energy is currently under rapid development. FUSE Taskforce and PG Course Leaders members include Atul Madan, Brian Dunkin, Dana Portenier, Dan Herron, Danny Scott, Dean Mikami, Esteban Varela, Gerry Fried, Gretchen Purcell Jackson, Leena Khaitan, Sharon Bachman, Suvranu De, Thomas Robinson, Scott Melvin, Warren Grundfest, William Richardson, Stephanie Jones, Malcolm Munro, Randy Voyles, Mike Brunt, James Choi, Scott Helton, Jeff Hazey, David Iannitti, James Ulchaker, and Carla Bryant and Jessica Mischna (SAGES staff) – my sincere thanks to all of you for you hard work!
A pilot postgraduate course developed by the FUSE task force was rolled out at the SAGES annual meeting in San Antonio with didactic and hands-on components. These didactics are the basis for the upcoming SAGES FUSE manual to be published by Springer later this year. The task force which represents a multidisciplinary effort by general surgeons, gynecologists, anesthesiologists, urologists, nurses as well as others is hard at work refining the curriculum and developing validated assessment tools similar to those seen in FLS and FES. In addition to the manual, the curriculum will be available as a web-based tool and will be designed to meet surgical residency training needs and MOC requirements in the area of patient safety.
The challenges of providing specific tool-based training are formidable but not insurmountable. The current climate designed to protect operating room personnel from excessive sales based interactions also raises barriers to very important informal in-servicing an instrument instruction. SAGES’ positions concerning relationships with industry as a surgical professional society are stated in our white paper: https://www.sages.org/publication/id/COI/ ( see also Surg Endosc. 2010 Apr;24(4):742-4.) This document goes on to describe why a transparent relationship of surgical societies working with device makers as education partners is in the best interests of patient safety and high-quality surgical outcomes. The FUSE task force will work under this rubric with the makers of the most commonly used energy devices (who admittedly know the most about their specific devices) to independently create high-quality education modules designed to fill the tool specific knowledge gap.
Our goal is to help each surgical team perform at the most efficient and safest level, kind of like what you would expect from your pilots and flight crew and next time you step into in a plane. The WHO got it right with the Checklist mantra: safe surgery saves lives.
If you have suggestions for the FUSE project or wish to participate, please write me at President@SAGES.org.
Steve Schwaitzberg