title: Long-term knowledge retention following simulation-based training for electrosurgical safety: 1-year follow-up of a randomized controlled trial.
abstract: BACKGROUND
  Despite the value of simulation for surgical training, it is unclear whether acquired competencies persist long term. A prior randomized trial showed that structured simulation improves knowledge of the safe use of electrosurgery (ES) amongst trainees up to 3 months after the curriculum (Madani et al. in Surg Endosc 28(10):2772-2782, 2014). We now analyse long-term knowledge retention. This study estimates the effects of a structured simulation-based curriculum to teach the safe use of ES on knowledge after 1 year.
  
  
  METHODS
  Trainees previously participated in a 1-h didactic ES course, followed by randomization into 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). Knowledge of pre- and post-curriculum (immediate, 3 months and 1 year) and knowledge of ES safety were assessed using different multiple-choice examinations. Data are expressed as median (interquartile range), *p < 0.05.
  
  
  RESULTS
  Fifty-nine trainees participated (30 control group; 29 Sim group). Despite equal baseline examination scores, Sim group demonstrated higher scores compared to control immediately (89% [83; 94] vs. 83% [71; 86]*), 3 months (77% [69; 90] vs. 60% [51; 80]*) and 1 year after curriculum (70% [61; 74] vs. 60% [31; 71]*). One-year score remained significantly greater compared to baseline in the Sim group (70% [61; 74] vs. 49% [43; 57]*), but was similar to baseline in the control group (60% [31; 71] vs. 45% [34; 52]).
  
  
  CONCLUSIONS
  After ES simulation training, retention of competencies persists longer when the hands-on component is designed to reinforce specific learning objectives in a structured curriculum. Despite routine clinical use of ES devices, knowledge degrades overtime, suggesting the need for ongoing formal educational activities to reinforce curricular objectives.
authors.affiliation: Department of Surgery, McGill University, Montreal, QC, H3G 1A4, Canada. amin.madani@mail.mcgill.ca.|Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, 1650 Cedar Avenue, Rm L9-309, Montreal, QC, Canada. amin.madani@mail.mcgill.ca.
authors.forename: Amin
authors.initials: A
authors.lastname: Madani
authors.affiliation: Department of Surgery, McGill University, Montreal, QC, H3G 1A4, Canada. ywatanabe328@gmail.com.|Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, 1650 Cedar Avenue, Rm L9-309, Montreal, QC, Canada. ywatanabe328@gmail.com.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Department of Surgery, McGill University, Montreal, QC, H3G 1A4, Canada. melina.vassiliou@mcgill.ca.|Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, 1650 Cedar Avenue, Rm L9-309, Montreal, QC, Canada. melina.vassiliou@mcgill.ca.
authors.forename: Melina C
authors.initials: MC
authors.lastname: Vassiliou
authors.affiliation: The Permanente Medical Group, Kaiser Medical Center, Walnut Creek, CA, USA. pascal.fuchshuber@kp.org.
authors.forename: Pascal
authors.initials: P
authors.lastname: Fuchshuber
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA. djones1@bidmc.harvard.edu.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Jones
authors.affiliation: Department of Surgery, Cambridge Health Alliance, Cambridge, MA, USA. sschwaitzberg@challiance.org.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Schwaitzberg
authors.affiliation: Department of Surgery, McGill University, Montreal, QC, H3G 1A4, Canada. gerald.fried@mcgill.ca.|Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, 1650 Cedar Avenue, Rm L9-309, Montreal, QC, Canada. gerald.fried@mcgill.ca.
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Fried
authors.affiliation: Department of Surgery, McGill University, Montreal, QC, H3G 1A4, Canada. liane.feldman@mcgill.ca.|Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, 1650 Cedar Avenue, Rm L9-309, Montreal, QC, Canada. liane.feldman@mcgill.ca.
authors.forename: Liane S
authors.initials: LS
authors.lastname: Feldman
mesh_terms: D002983:Clinical Competence; D003479:Curriculum; D004598:Electrosurgery / Q000193:education*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012153:Retention, Psychology; D000066908:Simulation Training
keywords: Curriculum; Education; Electrosurgery; Energy; FUSE; Simulation