World Journal of Surgery

, Volume 43, Issue 1, pp 9–15 | Cite as

Trends in Retention and Decay of Basic Surgical Skills: Evidence from Addis Ababa University, Ethiopia: A Prospective Case–Control Cohort Study

  • Abebe Bekele
  • Sahlu Wondimu
  • Naod Firdu
  • Mulat Taye
  • Amezene TadesseEmail author
Original Scientific Report



While prior studies have evaluated surgical skills simulation and retention in highly resourced environments, there is paucity of data on the retention of surgical skills taught in simulation laboratory to undergraduate students, and virtually none from low-resource settings. We aimed to evaluate the trends in retention/decay of surgical skills among medical students in Ethiopia and determine whether regular intervention in the form of intermittent skills testing can aid retention.


Forty-four final year medical students were randomly divided into two cohorts of 22 students each. All 44 were trained in surgical instrument identification, simple interrupted suturing and one-handed knot tying. A previously validated, standardized assessment was performed before training, immediately after training, and then at 6 weeks, 3 months, 6 months and 1 year for cohort 1, and before training, immediately after training, and at 6 months and 1 year for cohort 2. All areas learned were tested for general decay.


The baseline mean scores of surgical skills were 3.8/30 for instrument identification, 3.3/15 for one-handed knot tying, and 1.35/15 for suturing. At the end of the training, mean scores improved to 26.6/30, 11.2/15 and 11.1/15 (instrument identification +599% and +772%, knot tying +447% and +417%, suturing +237% and +260%, respectively, for Cohort I and II). At 6 months and 1 year, there was a significant drop in all the three areas tested, especially in knot tying and suturing. There was no statistically significant difference between the two cohorts.


While our surgical skills course is an effective means to teach surgical skills to medical students, there is significant decay in abilities after 6 months. Conducting regular assessments does not appear to have any effect in helping students retain these skills. We recommend such surgical skills training be conducted at appropriate intervals, such as just before internship, to prepare student for active surgical practice.



Objective structured assessment of technical skills


Analysis of variance



We would like to acknowledge the medical students who participated in the study. We would also like to pass our gratitude the faculty in FAIMER who helped us in the actual implementation of the study. We thank the Department of Surgery for allowing us to use the skills laboratory. We would like to thank Dr. Thomas Weiser from Stanford University Department of Surgery for his help reviewing the final manuscript and his assistance preparing it for publication.

Author contributions

AB designed the study as part of his FAIMER project. He participated in questioner preparation, data collection, write up and approval of the final manuscript. SW participated in questioner preparation, data collection, write up and approval of the final manuscript. NF was involved in the statistical analysis, interpretation of results and write up. AT participated in questioner preparation, data collection, write up and approval of the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors would like to disclose that they have no conflict of interest.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Consent for publication

Not Applicable.

Ethical approval

Ethical approval was obtained from the Research committee of Department of Surgery, School of Medicine, Addis Ababa University.


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Abebe Bekele
    • 1
  • Sahlu Wondimu
    • 1
  • Naod Firdu
    • 2
  • Mulat Taye
    • 3
  • Amezene Tadesse
    • 1
    Email author
  1. 1.Department of Surgery, School of MedicineAddis Ababa UniversityAddis AbabaEthiopia
  2. 2.School of Public HealthAddis Ababa UniversityAddis AbabaEthiopia
  3. 3.School of MedicineAddis Ababa UniversityAddis AbabaEthiopia

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