title: Structured simulation improves learning of the Fundamental Use of Surgical Energy™ curriculum: a multicenter randomized controlled trial.
abstract: BACKGROUND
  Energy devices can result in devastating complications to patients. Yet, they remain poorly understood by trainees and surgeons. A single-institution pilot study suggested that structured simulation improves knowledge of the safe use of electrosurgery (ES) among trainees (Madani et al. in Surg Endosc 28(10):2772-2782, 2014). 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.
  
  
  METHODS
  Trainees from 11 residency programs in Canada, the USA and UK participated in a 1-h didactic ES course, based on SAGES' Fundamental Use of Surgical Energy™ (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 (immediately and 3 months after) knowledge of the safe use of ES was assessed using separate examinations. Data are expressed as mean (SD) and N (%), *p < 0.05.
  
  
  RESULTS
  A total of 289 (145 control; 144 Sim) trainees participated, with 186 (96 control; 90 Sim) completing the 3-month assessment. Baseline characteristics were similar between the two groups. Total score on the examination improved from 46% (10) to 84% (10)* for the entire cohort, with higher post-curriculum scores in the Sim group compared with controls [86% (9) vs. 83% (10)*]. All scores declined after 3 months, but remained higher in the Sim group [72% (18) vs. 64% (15)*]. Independent predictors of 3-month score included pre-curriculum score and participation in a goal-directed simulation.
  
  
  CONCLUSIONS
  This multi-institutional study confirms that a 2-h curriculum based on the FUSE program improves surgical trainees' knowledge in the safe use of ES devices across training programs with various geographic locations and resident volumes. The addition of a structured interactive bench-top simulation component further improved learning.
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, 1650 Cedar Avenue, Rm L9-309, Montreal, QC, H3G 1A4, Canada. amin.madani@mail.mcgill.ca.
authors.forename: Amin
authors.initials: A
authors.lastname: Madani
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, 1650 Cedar Avenue, Rm L9-309, Montreal, QC, H3G 1A4, Canada.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Townsend
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: Philip H
authors.initials: PH
authors.lastname: Pucher
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Robinson
authors.affiliation: Department of Surgery, Université de Montréal, Montreal, QC, Canada.
authors.forename: Patricia E
authors.initials: PE
authors.lastname: Egerszegi
authors.affiliation: Department of Surgery, Harvard University, Boston, MA, USA.
authors.forename: Jaisa
authors.initials: J
authors.lastname: Olasky
authors.affiliation: Inova Medical Group - Surgical Services, Falls Church, VA, USA.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Bachman
authors.affiliation: Department of Surgery, Duke University, Durham, NC, USA.
authors.forename: Chan W
authors.initials: CW
authors.lastname: Park
authors.affiliation: Department of Surgery, McMaster University, Hamilton, ON, Canada.
authors.forename: Nalin
authors.initials: N
authors.lastname: Amin
authors.affiliation: Department of Surgery, Dalhousie University, Halifax, NS, Canada.
authors.forename: David T
authors.initials: DT
authors.lastname: Tang
authors.affiliation: Department of Surgery, University of Alberta, Edmonton, AB, Canada.
authors.forename: Erika
authors.initials: E
authors.lastname: Haase
authors.affiliation: Department of Surgery, Queen's University, Kingston, ON, Canada.
authors.forename: Davide
authors.initials: D
authors.lastname: Bardana
authors.affiliation: Department of Surgery, Harvard University, Boston, MA, USA.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Jones
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, 1650 Cedar Avenue, Rm L9-309, Montreal, QC, H3G 1A4, Canada.
authors.forename: Melina
authors.initials: M
authors.lastname: Vassiliou
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, 1650 Cedar Avenue, Rm L9-309, Montreal, QC, H3G 1A4, Canada.
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Fried
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, 1650 Cedar Avenue, Rm L9-309, Montreal, QC, H3G 1A4, Canada.
authors.forename: Liane S
authors.initials: LS
authors.lastname: Feldman
mesh_terms: D000328:Adult; D002170:Canada; D002983:Clinical Competence; D003479:Curriculum; D004598:Electrosurgery / Q000193:education* / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D000066908:Simulation Training / Q000379:methods*; D006113:United Kingdom; D014481:United States
keywords: Curriculum; Education; Electrosurgery; Energy device; FUSE; Simulation