Stephanie B. Jones

Fundamental use of surgical energy (FUSE) closing a gap in medical education

Traditional medical education curricula for students, residents and trainees do not address the rapidly growing number of technological devices that are fundamentally changing health care delivery today. This is most relevant in those medical specialties that rely heavily on the use of advanced technologies and devices, for example minimally invasive surgery, interventional radiology, gastroenterology, cardiology and anesthesia. Health care professionals in these domains are increasingly sharing procedures that use energy devices of many different designs and functionality without training in their fundamental use and safety. This exposes both operators and patients to increasing risk for injury. The definitive gap in adequate education and training in new technologies prompted the development of The Fundamental Use of Surgical Energy (FUSE) program by a multidisciplinary team of clinicians, nurses, educators and engineers under the leadership of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). The sweeping changes in the surgical and interventional professions due to technological innovation call for the development of additional curricula to close the educational gap on other medically important technologies. The FUSE program and future educational curricula on medical technologies are fundamental to patient care and represent a necessary paradigm shift in traditional medical education.

Are we closing the gap in faculty development needs for feedback training

STUDY OBJECTIVE To determine needs, adequacy, types of resources, and challenges in teaching faculty how to provide feedback to residents. DESIGN Survey instrument. SETTING Academic medical center. PARTICIPANTS Of the 115 anesthesia residency program directors surveyed, 69 responses were received (60% response rate). MEASUREMENTS Percentages of respondents who indicated categories of need, adequacy, and types of resources for teaching faculty to give feedback to residents were recorded, as were narrative descriptions of challenges confronted by respondents. MAIN RESULTS While the percentage of programs with faculty development resources has increased from 20.2% in 1999 to 48% today, an overwhelming majority of program directors (90%) feel that faculty require more training in providing feedback to residents. The majority of program directors also want more resources to train their faculty in providing feedback. CONCLUSIONS While the perceived gap in providing training for faculty in giving feedback to anesthesia residents has narrowed, program director responses suggest a substantial unmet need remains. Innovative new approaches are in order.

Improving Quality Through Multidisciplinary Education

Multidisciplinary education (MDE) is perceived as the next means of implementing major improvements in the quality and cost-effectiveness of patient care. In this article, the authors discuss various definitions of MDE, evaluate how MDE might be implemented in clinical arenas relevant to the anesthesiologist, and describe several implementations of MDE within their hospital and the anesthesiology department.

The SAGES Fundamental Use of Surgical Energy program (FUSE): history, development, and purpose

BackgroundAdverse events due to energy device use in surgical operating rooms are a daily occurrence. These occur at a rate of approximately 1–2 per 1000 operations. Hundreds of operating room fires occur each year in the United States, some causing severe injury and even mortality. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) therefore created the first comprehensive educational curriculum on the safe use of surgical energy devices, called Fundamental Use of Surgical Energy (FUSE). This paper describes the history, development, and purpose of this important training program for all members of the operating room team.MethodsThe databases of SAGES and the FUSE committee as well as personal photographs and documents of members of the FUSE task force were used to establish a brief history of the FUSE program from its inception to its current status.ResultsThe authors were able to detail all aspects of the history, development, and national as well as global implementation of the third SAGES Fundamentals Program FUSE.ConclusionsThe written documentation of the making of FUSE is an important contribution to the history and mission of SAGES and allows the reader to understand the idea, concept, realization, and implementation of the only free online educational tool for physicians on energy devices available today. FUSE is the culmination of the SAGES efforts to recognize gaps in patient safety and develop state-of-the-art educational programs to address those gaps. It is the goal of the FUSE task force to ensure that general FUSE implementation becomes multinational, involving as many countries as possible.

Updated panel report: best practices for the surgical treatment of obesity

BackgroundDuring the 2004 annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), a panel of experts convened to provide updated information on best practices in bariatric surgery. The rapid evolution of endoluminal technologies, surgical indications, and training in bariatric surgery since 2004 has led to new questions and concerns about optimal treatment algorithms, patient selection, and the preparation of our current and future bariatric workforce.MethodsAn expert panel was convened at the SAGES 2017 annual meeting to provide a summative update on current practice patterns, techniques, and training in bariatric surgery in order to review and establish best practices. This was a joint effort by SAGES, International Society for the Perioperative Care of the Obese Patient, and the American Society for Metabolic and Bariatric Surgery.ResultsOn March 23, 2017, seven expert faculty convened to address current areas of controversy in bariatric surgery and provide updated guidelines and practice recommendations. Areas addressed included the expanded indications for use of metabolic surgery in the treatment of diabetes, the safety and efficacy of new and investigational endoluminal procedures, updates on new guidelines for the management of airway and sleep apnea in the obese patient, the development of clinical pathways to reduce variation in the management of the bariatric patient, and new guidelines for training, credentialing, and bariatric program accreditation. The following article is a summary of this panel.ConclusionBariatric surgery is a field that continues to evolve. A timely, systematic approach, such as described here, that coalesces data and establishes best practices on the current body of available evidence is imperative for optimal patient care and to inform provider, insurer, and policy decisions.

Preoperative Risk Assessment: Anesthesia

Preanesthetic evaluation facilitates the safe and efficient perioperative management of a patient’s airway, cardiopulmonary physiology, and comorbid conditions. Preanesthesia assessment and further diagnostic testing should be tailored to the unique medical history of the patient and the planned operative procedure.

Preoperative Evaluation of the Healthy Laparoscopic Patient

1. The goal of preoperative evaluation is to identify and modify risk factors that might adversely effect anesthetic care and surgical outcome. 2. Up to 50% of patients presenting for elective surgery are regarded as “healthy.” These patients typically fall into American Society of Anesthesiologists (ASA) Physical Status I (healthy) and II (mild systemic disease). The ASA Physical Status classification (Table 1.1) is not intended to predict outcomes, nor does it incorporate risks specific to the type of surgery performed. 3. A patient presenting without established medical diagnoses is not necessarily healthy. He or she simply may have never previously visited a physician. Consequently, any physician visit, including preoperative evaluation, should be used as an opportunity to address routine preventive care (Table 1.2). 4. Preoperative evaluation should seek to determine absolute contraindications to laparoscopy. a. Inability to tolerate pneumoperitoneum b. Poor risk for general anesthesia c. Uncorrectable coagulopathy 5. The emphasis over the past decade has been a return to the use of the history and physical examination as the primary screening tools. Preoperative testing is used selectively. This approach is especially true in healthy patients.