Acquisition of suture skills during medical graduation by instructor-directed training: a randomized controlled study comparing senior medical students and faculty surgeons

Abstract

Due to shortage of time and limited availability of faculty surgeons to teach basic surgical skills during medical graduation, the search for alternative ways of simulated training with feedback is needed. The purpose of this study was to compare the simulated teaching of suture skills to novice medical students by senior medical students and by experienced faculty surgeons. Forty-eight novice medical students were randomly assigned to three practice conditions on bench model (n = 16): self-directed suture training (control), senior medical student-directed suture skills' training, or experienced faculty surgeon-directed suture skills' training. Pre- and post-tests were applied. Global Rating Scale with blinded evaluation and self-perceived confidence based on Likert scale were used to assess all suture performances in pre- and post-training. Effect size was also calculated. The analysis made after training showed that the students who received feedback from the instructors had better performance based on the Global Rating Scale (all p < 0.0000) and felt more confident to carry out sutures (all p < 0.0000) when compared to the control. There was no significant difference (all p > 0.05) between the student-directed teaching and faculty-directed teaching groups. The magnitude of the effect (instructor-directed training suture) was considered large (>0.80) in all measurements. The acquisition of suture skills after student-directed training was similar to the training supervised by faculty surgeon, and the increase in suture performances of trainees that received instructor administered training was superior to self-directed learning.

Basic practical skills teaching and learning in undergraduate medical education – a review on methodological evidence

“…Better OSCE results were reported for students taught by full-time faculty versus part-time faculty [64]. Regarding suturing skills, peer teaching and faculty teaching lead to equal practical test results [6] and there was also no difference between being taught by a non-surgical skills coach versus being taught by a surgeon [23]. For injections skills, peer-teaching lead to similar student skills like faculty teaching [59].…”

“…Furthermore, real-time feedback with an apparatus measuring the force applied by the learner’s hand while tying a knot led to an appropriate decrease of the force needed for this sensitive task compared to a group without this specific feedback [35]. While one study showed that suture training with feedback lead to better suturing skills than self-directed suture training [6], other studies reported that self-guided suturing practice [3] or a self-directed schedule for suturing practice [47] were associated with better suturing skill acquisition and additional expert feedback lead to no further skill improvement [31]. Furthermore, voluntary participation in reflective writing and skills practice [54] and voluntary practice with positively deviant peers [62] led to better clinical skill performance of participating students.…”

“…Several studies showed that being taught by instructed peers or trained personnel, generalists or specialists, leads to similar skill performance in medical students [1], [6], [18], [23], [59], [63]. However, one study demonstrated that students showed better performance of bladder catheterization after being taught by an expert [58] and students who had been taught by full-time faculty performed better than students who were taught by part-time faculty [64].…”

“…Essential for feedback is the direct observation of the student by the instructor which is especially challenging in the current clinical environment and supported by practical tips [16]. However, for certain basic practical skills, peer teachers [6] and non-physician educators [23] seem to serve equally well as substitute instructors.…”

The role of student surgical interest groups and surgical Olympiads in anatomical and surgical undergraduate training in Russia

“…The University of Cape Town Surgical Society described by Leusink and Hoffmnan (2012) is also a student-run society that promotes medical and surgical research in order to motivate undergraduate medical students to pursue a career in surgery. Simulated training in suturing skills for junior students by senior students and surgeons was described by Denadai et al (2013). In the United Kingdom, the early introduction of basic surgical skills (BSS) program in the undergraduate curriculum increased the confidence and motivation of future medical graduates interested in surgical specialties, thus creating a recruitment pipeline for the surgical specialties (Hamaoui et al, 2013(Hamaoui et al, , 2014.…”