20.17 Incoming Residents’ Knot Tying and Suturing Skills: Are Medical School Boot Camps Sufficient?

R. McMillan¹, P. Redlich¹, R. Treat¹, M. Goldblatt¹, T. Carver¹, C. M. Dodgion¹, Z. Prewitt¹, J. R. Peschman¹, C. Davis¹, J. Grushka², T. Krausert¹, L. Olson¹, B. Lewis¹, M. J. Malinowski^{1  1}Medical College of Wisconsin,Surgery,Milwaukee, WI, USA ²McGill University Health Centre,Montreal, QUEBEC, Canada

Introduction:
Many medical schools offer M4 boot camps to improve student’s preparedness for residency. Significant faculty effort is expended in the design and teaching fundamental surgical skills in these courses. For three consecutive years, we studied the knot tying and suturing skills of incoming residents as part of a multi-day orientation program. We evaluated the impact of medical school boot camps on intern knot tying and suturing skills when measured at the start of residency.

Methods:
42 interns completed questionnaires over three-consecutive years regarding their M4 boot camp experiences.  In June of 2016-2018, interns were evaluated on suturing (18 one-point items), knot tying (16 one-point items), overall performance (1 five-point item, 5=high), and quality (1 five-point item) by three surgeons, blinded to the questionnaire results, using modified assessment forms published by the APDS/ACS for OSATS and global rating evaluation.  Descriptive statistics are reported with means (Mn) and standard deviation (s).  Scores were compared based on length of boot camp (≤ 10 days vs > 10 days), hours of supervised instruction (≤ 5 hours vs > 5 hours), and annual hours dedicated to practice of suturing and knot tying skills (≤ 10 hours vs > 10 hours).  The association of skills is reported with Spearman rho (SpR) correlations and inter-rater reliability determined by intraclass correlation coefficients (ICC). Analysis generated with IBM^® SPSS^® 24.0.

Results:

Over three years, 26 of 42 (62%) interns reported boot-camp training. In comparing groups with and without training, scores in suturing (9.6(4.6) vs 9.8(4.1), p<0.908), knot tying (9.1(3.6) vs 8.4(4.1), p<0.574), overall performance (2.0(0.6) vs 1.9(0.7), p<0.424), and quality (2.0(0.6) vs 1.9(0.7), p<0.665) demonstrated no statistical significance.  All six pairwise correlations of the four skill evaluations were significant (SpR range=0.75-0.95), p<0.001), and ratings were consistent (ICC(2,1)=0.23-0.63, p<.002).  There was no significant difference in any of the four assessment scores when split by completion of boot camp, length of boot camp, hours of supervised instruction, or hours dedicated to practice.

Conclusion:
Our study could not demonstrate a statistically significant benefit in knot tying and suturing skills of students who enroll in M4 boot camp courses as measured at the start of residency. However, suturing and knot tying ratings were strongly related to each other and overall quality and performance. This finding indicates that faculty are evaluating consistent levels of suturing and knot tying skills for each intern, and that the skills are strong indicators of overall performance.  Residency programs should be prepared to teach these skills to their entering residents. Further study is warranted to evaluate the benefit of boot camps on other technical skills of incoming residents.