S. L. Cemaj1, T. Connely1, H. Hon3, K. Tieken2, S. Figy3, S. Wong3, A. Fingeret2 1University Of Nebraska College Of Medicine, College Of Medicine, Omaha, NE, USA 2University Of Nebraska College Of Medicine, Department Of Surgery, Omaha, NE, USA 3University Of Nebraska College Of Medicine, Department Of Plastic And Reconstructive Surgery, Omaha, NE, USA
Introduction:
Medical students are expected to be able to perform basic suturing upon graduation. However, technical skills training for suturing is not frequently incorporated into the preclinical medical school curriculum. A proposed concept to increase exposure to suturing is to integrate art into practice by mixing cross-stitching with suturing. We hypothesize that preclinical students trained with this “cross-suturing” method demonstrate improved subjective and objective suturing performance.
Methods:
Students in their pre-clinical years were voluntarily recruited to participate in this randomized controlled study. Students were randomly assigned to the control versus cross-stitch intervention group. Both groups were provided with a basic suturing video they could review prior to the session. The intervention group participated in an art class where they were able to practice cross-suturing while the control group was sent home with suturing supplies. Measurements were conducted pre-intervention, post-intervention, and at a 2-week follow up. Their skills were measured through a mixed methods study approach. Their subjective score was graded on a Likert scale ranging from 1-4 measuring proficiency, confidence, and anxiety levels for a total of 12 points. Their objective score was measured through a deidentified video recording 5 simple interrupted sutures on a pig’s foot and were graded by two blinded expert raters using the American College of Surgeons (ACS) basic suturing and knot tying performance rating tool and Global Rating Scale (GRS) for a total of 30 points. Statistical analysis was performed using unpaired t-tests.
Results:
A total of 16 pre-clinical medical students participated. Likert and ACS scores were comparable in the pre-intervention measurements (Likert: Control 5.6±1.5 vs. Intervention 5.9±1.1, p=0.713; ACS: Control 15.4±1.9 vs. Intervention 18.0±3.5, p=0.0947). The intervention group showed significant improvement relative to the control group at the post-intervention measurements (Likert: Control 6.6±1.1 vs. Intervention 8.8±0.9, p=0.0007) and (ACS: Control 16.5±2.1 vs. Intervention 24.6±3.2, p=0.0001). The intervention group showed retained skills at the 2-week follow up (Likert: Intervention Post 8.8±0.9 vs. Intervention 2-week 8.5±0.8, p=0.6027) and (ACS: Intervention Post 24.6±3.2 vs. Intervention 2-week 25.2±2.1, p=0.7276).
Conclusion:
The cross-suturing approach has proven to be an effective method to improve suturing skills amongst pre-clinical medical students. This low cost and engaging approach to medical student surgical education should be explored with more medical students to better prepare them for their clinical years.
