University of Texas MD Anderson Cancer Center Houston, TX
Sanji Suresh, MEd, BA, Gottumukkala S. Raju, MD, Hao Chi Zhang, MD; University of Texas MD Anderson Cancer Center, Houston, TX
Introduction: Knowledge gaps in electrosurgical unit (ESU) operations among surgeons, which impact operator and patient safety, are well-documented. However, similar data in gastroenterology are lacking despite ubiquitous use of this device in the endoscopy unit. Our goal was to assess the baseline knowledge of the ESU among primarily GI trainees and endoscopy technicians. Methods: A longitudinal pilot study was designed to assess the knowledge of trainees and endoscopy technicians at an academic institution. Participation was voluntary. A multiple-choice examination was formulated to test pre-defined learning objectives (Figure 1). Demographics and work experience data were collected (Figure 2). We administered a pre-test (baseline knowledge) followed by a lecture (Session 1). One week later, we held a hands-on demonstration with an assessment of ESU functional operations (Session 2) and a repeat exam. Knowledge was reassessed after 3 months via an online exam. The data was collected and analyzed. Results: Twelve trainees (11 GI fellows, 1 surgical resident) and 7 endoscopy technicians participated; background details are presented in Figure 2. Before Session 1, the mean reported comfort levels with the principles of ESU (on a scale 1-5) were 2.3 vs. 3.9, and 2.3 vs. 3.7 with physical ESU operations, among trainees vs. technicians, respectively. On the pre-test, the mean score was 57% among 11 GI fellows (confidence of 20-40%), 42% in 1 surgical resident (confidence of 20-40%), and 53% among 7 technicians (confidence of 67-87%). After Session 2, 5 GI fellows scored a mean of 79% (confidence of 55-75%). At 3 months, 8 GI fellows scored a mean of 73% (confidence of 56%) vs. 67% among 3 technicians (confidence of 78%). Practical questions on the exam were answered 61%, 85%, and 76% correctly, in series, on each of the exams. See Figure 3 for detailed data. Discussion: Baseline ESU knowledge and self-confidence were deemed suboptimal in all participants. Lecture and a hands-on session provided immediate benefit, but knowledge retention may regress. Overall, participants scored higher at 3 months compared to baseline. Consistent participation was challenging to achieve in this design. Integrating a standardized or formalized curriculum for trainees and staff can improve confidence and practical knowledge of the ESU and achieve adequate cross-training, thereby positively impacting performance and patient safety. This study revealed challenges and limitations to be addressed in more robust future studies.
Figure 1. Educational objectives were defined and established for the purpose of assessing knowledge regarding principles, operations, and applications of the ESU in the endoscopy suite. The multiple-choice exam was designed to address Objectives 1-15. Objective 16 was assessed only during Session 2, the hands-on demonstration of the ESU, where participants were expected to perform basic tasks on the ESU under observation.
Figure 2. Demographic data and education background of all participants were collected via survey at the beginning of Session 1, except for 1 GI fellow who only participated in Session 2, after which demographic data was collected.
Figure 3. Primary results of the study. The graph demonstrates trends of exam scores across sequential components of the study, delineated by participant type. All available exam scores were included regardless if the participant was present for Session 1, Session 2, or both sessions. A table of individual exam score results are juxtaposed with self-reported information regarding comfort level and perception of how one scored after taking the exam. The last table provides results regarding trends in overall exam scores categorized by practical vs. theoretical. The subcategory "practice-critical" reflects practical knowledge that could have implications on immediate adverse effects or outcomes during an endoscopic case.
Disclosures: Sanji Suresh indicated no relevant financial relationships. Gottumukkala Raju indicated no relevant financial relationships. Hao Chi Zhang indicated no relevant financial relationships.