Surgeons don't know what they don't know about the safe use of energy in surgery

Surg Endosc. 2012 Oct;26(10):2735-9. doi: 10.1007/s00464-012-2263-y. Epub 2012 Apr 27.


Background: Surgeons are not required to train on energy-based devices or document their knowledge of safety issues related to their use. Their understanding of how to safely use the devices has never formally been tested. This study assessed that knowledge in a cohort of gastrointestinal surgeons and determined if key facts could be learned in a half-day course.

Methods: SAGES piloted a postgraduate CME course on the Fundamental Use of Surgical Energy™ (FUSE) at the 2011 SAGES meeting. Course faculty prepared an 11-item multiple-choice examination (pretest) of critical knowledge. We administered it to members of the SAGES board; Quality, Outcomes and Safety Committee; and FUSE Task Force. Postgraduate course participants took the pretest, and at the end of the course they took a 10-item post-test that covered the same content. Data are expressed as median (interquartile range, IQR).

Results: Forty-eight SAGES leaders completed the test: the median percent of correct answers was 59 % (IQR = 55-73 %; range = 0-100 %). Thirty-one percent did not know how to correctly handle a fire on the patient; 31 % could not identify the device least likely to interfere with a pacemaker; 13 % did not know that thermal injury can extend beyond the jaws of a bipolar instrument; and 10 % thought a dispersive pad should be cut to fit a child. Pretest results for 27 participants in the postgraduate course were similar, with a median of 55 % correct (IQR = 46-82 %). Participants were not told the correct answers. At the end of the course, 25 of them completed a different 10-item post-test, with a median of 90 % correct (IQR = 70-90 %).

Conclusions: Many surgeons have knowledge gaps in the safe use of widely used energy-based devices. A formal curriculum in this area can address this gap and contribute to increased safety.

MeSH terms

  • Aged
  • Catheter Ablation / instrumentation
  • Cohort Studies
  • Curriculum
  • Digestive System Surgical Procedures / instrumentation
  • Education, Medical, Continuing*
  • Educational Measurement
  • Electrical Equipment and Supplies
  • Electrosurgery / education*
  • Electrosurgery / instrumentation*
  • Endoscopes
  • Equipment Design
  • Equipment Safety
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Microwaves
  • Middle Aged
  • Ultrasonics / instrumentation