Needs assessment for electrosurgery training of residents and faculty in obstetrics and gynecology

Proficient until proven unproficient? Exploring attitudes and perceptions of medical specialists on proficiency, proficiency requirements and proficiency tests for electrosurgery

BACKGROUND

The correct and safe use of electrosurgery requires medical specialists to be proficient. Minimum proficiency requirements and proficiency tests are a manner to structurally assure proficiency. The objective of this study is to explore attitudes and perceptions of medical specialists on proficiency, proficiency requirements and proficiency tests for the safe use of electrosurgery.

METHODS

A qualitative study among medical specialists using semi-structured interviews.

RESULTS

The participants recognized that the use of electrosurgery poses risks to the safety of patients and perioperative staff. According to some participants, increased awareness on the risks of electrosurgery is required. Most medical specialists however thought that proficiency of users of electrosurgery is sufficiently assured. Medical specialists stated to support proficiency requirements when they are endorsed by their scientific association. Proficiency tests encountered much resistance. Medical specialists argued that electrosurgery should not be tested as a single device but should be embedded in a larger entity, for example in a broader course or proficiency test.

CONCLUSIONS

When assuring proficiency of users of electrosurgery, the positive attitude towards proficiency requirements and the more negative attitude towards proficiency tests should be taken into account.

Electrosurgery: short-circuit between education and practice

Introduction: Electrosurgery is used in 80% of surgical procedures. The technique allows surgeons to skilfully dissect tissues and achieve haemostasis. Since improper use of electrosurgery can lead to serious adverse events, training is required to potentially reduce the number and severity of these events. In this study we evaluate education and training in electrosurgery for surgical residents. Material and methods: Residents from six surgical subspecialties in the Netherlands were invited to anonymously complete a digital questionnaire about training, supervision and adverse events regarding electrosurgery. Results: Of the 197 respondents, 69% had received some form of training; mostly a single theoretical lecture. The feeling of competence in theory and practical skills was positively rated by 39% and 71%, respectively. Moreover, 35% judged the theoretical knowledge of their supervisors as insufficient and 65% changed their electrosurgical application technique to the preference of the supervisor. 30% of the residents had encountered a serious adverse event (e.g., burn wounds) related to the application of electrosurgery. Conclusions: The training of residents in theoretical aspects of electrosurgery is limited. Residents are not satisfied with the acquired theoretical knowledge of themselves and of their supervisors. Since adverse events related to electrosurgery occur frequently, more extensive education for both residents and their supervisors is needed to enhance patient safety.

Barriers to implementation of the FUSE program

INTRODUCTION

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) developed The Fundamental Use of Surgical Energy (FUSE) Program to promote safe use of energy devices in the operating room and endoscopy suite. Utilization of the program has been slower than anticipated. This study aims to determine the barriers to implementing FUSE.

METHODS

An anonymous survey was distributed to a surgery department at an academic teaching hospital (n = 256). Participants indicated their level of training. Answers were measured using a 5-point Likert scale.

RESULTS

There were 94 (36.7%) respondents to the survey from September 7 to 20, 2016. Fifteen surveys were incomplete, leaving 79 responses for analysis. Most respondents were at the faculty level (45/79, 57.0%). The majority had heard of FUSE (62/79, 78.5%), but only 19 had completed the certification (19/62, 32.3%). There was no difference in the completion rate between faculty and trainees (26.7 vs. 20.6%, OR 1.4, 95% CI 0.49-4.06, p = 0.53). The most common reasons for not taking the exam were lack of time to study (26/43, 60.5%) and lack of time to take the exam (28/43, 62.1%); however, cost was not a barrier (12/43, 27.9%). The majority identified a personal learning gap regarding the safe use of surgical energy (30/43, 69.7%). Of the 19 FUSE-certified respondents, reasons cited for completing the exam included wanting to prevent adverse events to patients and in the operating room (17/19, 89.5% and 17/19, 89.5%), and the belief that the course would make them a safer surgeon (16/19, 84.2%).

CONCLUSIONS

FUSE teaches the proper use of radiofrequency energy, how to prevent unnecessary injury, and promotes safe practice. Close to three out of every four surgeons self-identified a personal knowledge gap regarding the safe use of surgical energy. Time restraints were cited most commonly as the barrier to starting and completing FUSE. Integrating the FUSE program into resident educational conferences, faculty grand rounds, or national conferences may help improve participation and drive adoption of FUSE certification.

Do Turkish gynecologists have sufficient knowledge on the basic principles of electrosurgery?

AIM

The aim of the current study was to evaluate the level of the basic knowledge of the Turkish gynecologists regarding electrosurgery.

MATERIALS AND METHODS

A survey was undertaken to evaluate the level of basic knowledge and attitudes regarding electrosurgery use among gynecology specialists and residents. The questionnaire used comprised of two parts: a) questions evaluating the participants' professional experience, whether they had received formal electrosurgery training, and their course of action concerning the use and safety precautions of the electrosurgery unit, and b) questions designed to evaluate the knowledge level of the participants on the basic electrosurgical principles.

RESULTS

One hundred seventy-three gynecologists were included in the study and their mean knowledge score was 49.1 %. No difference was detected between the mean scores of specialists and residents. The mean score of participants who had read articles/papers on electrosurgery was significantly higher compared with uninformed participants (p =0.001). The mean score of participants who had previously attended electrosurgery training seminars was significantly higher compared with participants who had not attended seminars (p =0.013).

CONCLUSION

Gynecologists in Turkey do not have sufficient basic knowledge regarding the reliable and efficient use of electrosurgery. HIPPOKRATIA 2017, 21(1): 8-12.