Feedback Versus Compliments Versus Both in Suturing and Knot Tying Simulation: A Randomized Controlled Trial.

INTRODUCTION: Suturing is an expected skill for students graduating from health professions programs. Previous studies investigated student experience with teaching sessions utilizing constructive feedback versus compliments but did not investigate the combination of both. METHODS: In this parallel, randomized controlled trial, participants were divided into three groups: feedback (F), compliments (C), or feedback and compliments (FC). Participants received standardized instruction on simple interrupted suturing and two-handed knot-tying, and were videotaped performing this skill before and after the intervention. Performance was evaluated using a validated Objective Structured Assessment of Technical Skills (OSATS) instrument. Participants completed a preintervention and postintervention survey rating their task enjoyment and self-assessment of performance. Analysis was performed to determine differences between and within the groups using Kruskal-Wallis, Wilcoxon rank-sum, and Mann-Whitney U tests. RESULTS: A total of 31 students participated: 11 in C, 10 in F, and 10 in FC. The groups had similar preintervention OSATS scores. The F and FC groups demonstrated significant improvement in OSATS score after intervention, group C was not significantly different: F median of 11.25-19.75 points (P = 0.002); FC median of 11.75-21 points (P = 0.002); C median of 13-14 points (P = 0.2266). Between the groups FC and F both had significant performance improvement compared with C (P < 0.001 and P = 0.001 respectively). The FC group had a significantly higher rating of their enjoyment of the task on the postintervention survey compared with both the C and F groups with a median rating of 10 compared with 8 and 8 (P = 0.0052 and P = 0.0126, respectively). CONCLUSIONS: The combination of feedback and compliments was associated with improvement in performance on suturing and knot-tying similar to the feedback-only group. The FC group rated a higher level of enjoyment of the activity compared to feedback or compliments alone.

Cross-Suturing is Effective for Teaching Suturing Skills: A Randomized, Controlled Trial.

INTRODUCTION: Basic suturing is a skill expected from graduating medical students. A proposed concept to increase suturing competency is to integrate art by mixing cross-stitching with suturing. We hypothesize that students trained with "cross-suturing" would improve suturing performance. METHODS: We performed a randomized controlled trial of preclinical medical students using an art-based cross-stitching method intervention compared with conventional suturing. Both groups were provided with an introductory suturing video. Assessment of simple interrupted suturing were conducted preintervention and postintervention, and at 2-wk follow-up with a video review by blinded expert raters using the American College of Surgeons basic suturing and knot tying performance rating tool. Students completed a self-assessment of proficiency, confidence, and anxiety. Statistical analysis was performed using unpaired t-tests. RESULTS: A total of 16 preclinical medical students participated. Self-assessment and objective suturing performance were comparable in the preintervention measurements. The intervention group showed significant improvement compared to the control group with median (interquartile range) self-assessment scores 9 (8.5-9) compared with 6.5 (6-7.5) (P < 0.01) and objective performance scores of 25.25 (22.75-27) compared with 16.5 (14.5-18.5) (P < 0.01). The intervention group showed retained skills at the 2-wk follow up with no differences in self-assessment or objective suturing scores immediately postintervention compared with two-wk follow-up with self-assessment scores of 9 (8.5-9) versus 9 (8-9) at 2 wk (P = 0.16) and objective performance score of 25.25 (22.75-27) versus 24.75 (23.5-26.5) at 2 wk (P = 0.29). CONCLUSIONS: The cross-suturing intervention improved suturing skills in this cohort. This low-cost approach to medical student surgical education should be explored on a larger scale.