Abstract
Background
Suturing is a fundamental skill in undergraduate medical education. It can be taught by faculty-led, peer tutor-led, and holography-augmented methods; however, the most educationally effective and cost-efficient method for proficiency-based teaching of suturing is yet to be determined.
Methods
We conducted a randomized controlled trial comparing faculty-led, peer tutor-led, and holography-augmented proficiency-based suturing training in pre-clerkship medical students. Holography-augmented training provided holographic, voice-controlled instructional material. Technical skill was assessed using hand motion analysis every ten sutures and used to construct learning curves. Proficiency was defined by one standard deviation within average faculty surgeon performance. Intervention arms were compared using one-way ANOVA of the number of sutures placed, full-length sutures used, time to proficiency, and incremental costs incurred. Surveys were used to evaluate participant preferences.
Results
Forty-four students were randomized to the faculty-led (n = 16), peer tutor-led (n = 14), and holography-augmented (n = 14) intervention arms. At proficiency, there were no differences between groups in the number of sutures placed, full-length sutures used, and time to achieve proficiency. The incremental costs of the holography-augmented method were greater than faculty-led and peer tutor-led instruction ($247.00 ± $12.05, p < 0.001) due to the high cost of the equipment. Faculty-led teaching was the most preferred method (78.0%), while holography-augmented was the least preferred (0%). 90.6% of students reported high confidence in performing simple interrupted sutures, which did not differ between intervention arms (faculty-led 100.0%, peer tutor-led 90.0%, holography-augmented 83.3%, p = 0.409). 93.8% of students felt the program should be offered in the future.
Conclusion
Faculty-led and peer tutor-led instructional methods of proficiency-based suturing teaching were superior to holography-augmented method with respect to costs and participants’ preferences despite being educationally equivalent.
Similar content being viewed by others
References
Mashaud LB, Arain NA, Hogg DC, Scott DJ (2013) Development, validation, and implementation of a cost-effective intermediate-level proficiency-based knot-tying and suturing curriculum for surgery residents. J Surg Educ 70(2):193–199
Gomez PP, Willis RE, Schiffer BL, Gardner AK, Scott DJ (2014) External validation and evaluation of an intermediate proficiency-based knot-tying and suturing curriculum. J Surg Educ 71(6):839–845
Wright AS, McKenzie J, Tsigonis A, Jensen AR, Figueredo EJ, Kim S et al (2012) A structured self-directed basic skills curriculum results in improved technical performance in the absence of expert faculty teaching. Surg (United States) 151(6):808–814
Vaughn CJ, Kim E, O’Sullivan P, Huang E, Lin MYC, Wyles S et al (2016) Peer video review and feedback improve performance in basic surgical skills. Am J Surg 211(2):355–360
Preece R, Dickinson EC, Sherif M, Ibrahim Y, Ninan AS, Aildasani L et al (2015) Peer-assisted teaching of basic surgical skills. Med Educ Online 20:27579
Hu Y, Choi J, Mahmutovic A, Kim H, Le IA, Rasmussen SK (2015) Assistant instructors facilitate simulation for medical students. J Surg Res 194(2):334–340
Routt E, Mansouri Y, de Moll EH, Bernstein DM, Bernardo SG, Levitt J (2015) Teaching the simple suture to medical students for long-term retention of skill. JAMA Dermatol 151(7):761
Cook DA, Brydges R, Hamstra SJ, Zendejas B, Szostek JH, Wang AT et al (2012) Comparative effectiveness of technology-enhanced simulation versus other instructional methods: a systematic review and meta-analysis. Simul Healthc 7(5):308–320
Sheahan G, Reznick R, Klinger D, Flynn L, Zevin B (2019) Comparison of faculty versus structured peer-feedback for acquisitions of basic and intermediate-level surgical skills. Am J Surg 217(2):214–221
Chien N, Trott T, Doty C, Adkins B (2015) Assessing the impact of accessible video-based training on laceration repair: a comparison to the traditional workshop method. West J Emerg Med 16(6):856–858
Korndorffer JR, Stefanidis D, Scott DJ (2006) Laparoscopic skills laboratories: current assessment and a call for resident training standards. Am J Surg 191(1):17–22
Zevin B, Dedy NJ, Bonrath EM, Grantcharov TP (2017) Comprehensive simulation-enhanced training curriculum for an advanced minimally invasive procedure: a randomized controlled trial. Surg Obes Relat Dis 13(5):815–824
Stefanidis D, Acker C, Heniford TB (2008) Proficiency-based laparoscopic simulator training leads to improved operating room skill that is resistant to decay. Surg Innov 15(1):69–73
Harris P, Snell L, Talbot M, Harden RM (2010) Competency-based medical education: implications for undergraduate programs. Med Teach 32(8):646–650
Lin Y, Cheng A, Hecker K, Grant V, Currie GR (2018) Implementing economic evaluation in simulation-based medical education: challenges and opportunities. Med Educ 52(2):150–160
Tolsgaard MG, Tabor A, Madsen ME, Wulff CB, Dyre L, Ringsted C et al (2015) Linking quality of care and training costs: cost-effectiveness in health professions education. Med Educ 49(12):1263–1271
Hu Y, Kim H, Mahmutovic A, Choi J, Le I, Rasmussen S (2015) Verification of accurate technical insight: a prerequisite for self-directed surgical training. Adv Health Sci Educ Theory Pract 20(1):181–191
Schulz KF, Altman DG, Moher D (2010) Consort 2010 statement: updated guidelines for reporting parallel group randomized trials. BMC Med. 8(1):18
Lia H, Paulin G, Yeo CT, Andrews J, Yi N, Haq H, et al. HoloLens in suturing training. In: Medical imaging 2018: image-guided procedures, robotic interventions, and modeling; 2018
Canadian Institute for Health Information (CIHI) (2010) National physician database, 2008–2009. Canadian Institute for Health Information, Ottawa
CFPC, CMA RC (2014) National physician survey. CFPC, Mississauga
Collective Agreement between The Public Service Alliance of Canada on behalf of Graduate Teaching Assistants and Teaching Fellows Queen’s University at Kingston; 2013, pp 1–47
Abay EŞ, Turan S, Odabaşı O, Elçin M (2017) Who is the preferred tutor in clinical skills training: physicians, nurses, or peers? Teach Learn Med 29(3):247–254
Powell DE, Carraccio C (2018) Toward competency-based medical education. N Engl J Med 378(1):3–5
Association of American Medical Colleges, Chen HC, van den Broek WES, Ten Cate O (2013) Core entrustable professional activities for entering residency. Acad Med 90(4):431–436
The Association of the Faculties of Medicine of Canada (2016) Entrustable professional activities for the transition from medical school to residency. https://afmc.ca/sites/default/files/documents/AFMC_Entrustable_Professional_Activities_EN_0.pdf. Accessed 4 July 2019.
Carraccio C, Englander R, Gilhooly J, Mink R, Hofkosh D, Barone MA et al (2017) Building a framework of entrustable professional activities, supported by competencies and milestones, to bridge the educational continuum. Acad Med 92(3):324–330
Datta V, Mackay S, Mandalia M, Darzi A (2001) The use of electromagnetic motion tracking analysis to objectively measure open surgical skill in the laboratory-based model. J Am Coll Surg 193(5):479–485
Palter VN, Grantcharov T, Harvey A, MacRae HM (2011) Ex vivo technical skills training transfers to the operating room and enhances cognitive learning: a randomized controlled trial. Ann Surg 253(5):886–889
De Montbrun SL, MacRae H (2012) Simulation in surgical education. Clin Colon Rectal Surg 25(3):156–165
Denadai R, Toledo AP, Oshiiwa M, Saad-Hossne R (2013) Acquisition of suture skills during medical graduation by instructor-directed training: a randomized controlled study comparing senior medical students and faculty surgeons. Updates Surg 65(2):131–140
Xeroulis GJ, Park J, Moulton CA, Reznick RK, LeBlanc V, Dubrowski A (2007) Teaching suturing and knot-tying skills to medical students: a randomized controlled study comparing computer-based video instruction and (concurrent and summary) expert feedback. Surgery 141(4):442–449
Zendejas B, Wang AT, Brydges R, Hamstra SJ, Cook DA (2013) Cost: the missing outcome in simulation-based medical education research: A systematic review. Surg (United States) 153(2):160–176
Nestel D, Brazil V, Hay M (2018) You can’t put a value on that… Or can you? Economic evaluation in simulation-based medical education. Med Educ 52(2):139–141
Microsoft. Hologram stability—mixed reality; 2018
Vassallo R, Rankin M, Chen ECS, Peters TM. Hologram stability evaluation for Microsoft HoloLens. In: Medical imaging 2017: image perception, observer performance, and technology assessment; 2017
Velamkayala ER, Zambrano MV, Li H (2017) Effects of HoloLens in collaboration: a case in navigation tasks. Proc Hum Factors Ergon Soc Annu Meet 61(1):2110–2114
Datta V, Mackay S, Darzi A, Gillies D (2002) The relationship between motion analysis and surgical technial assessments. Am J Surg 184:70–73
McGraw R, Chaplin T, McKaigney C, Rang L, Jaeger M, Redfearn D et al (2016) Development and evaluation of a simulation-based curriculum for ultrasound-guided central venous catheterization. Can J Emerg Med 18:405–413
Yeo CT, Davison C, Ungi T, Holden M, Fichtinger G, McGraw R (2015) Examination of learning trajectories for simulated lumbar puncture training using hand motion analysis. Acad Emerg Med 22(10):1187–1195
Palter VN, Orzech N, Reznick RK, Grantcharov TP (2013) Validation of a structured training and assessment curriculum for technical skill acquisition in minimally invasive surgery: a randomized controlled trial. Ann Surg 257(2):224–230
Funding
This study was supported by the Clinical Teaching Association of Queen’s University Endowment Fund. Madeline Lemke received the Society of American Gastrointestinal and Endoscopic Surgeons’ Medical Student Summer Research Award.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Dr. B. Zevin has received speaker fees from Ethicon Canada and research funding from Medtronic Canada.M Lemke, H. Lia, A. Gabinet-Equihua, G. Sheahan, A. Winthrop, S. Mann, and G. Fichtinger have no conflict of interest or financial ties to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Lemke, M., Lia, H., Gabinet-Equihua, A. et al. Optimizing resource utilization during proficiency-based training of suturing skills in medical students: a randomized controlled trial of faculty-led, peer tutor-led, and holography-augmented methods of teaching. Surg Endosc 34, 1678–1687 (2020). https://doi.org/10.1007/s00464-019-06944-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-019-06944-2