At-home medical student simulation: achieving knot-tying proficiency using video-based assessment.

ABSTRACT

Purpose: Due to the pandemic, we restructured our medical student knot-tying simulation to a virtual format. This study evaluated curriculum feasibility and effectiveness. Methods: Over 4 weeks, second-year medical students (n = 229) viewed a video tutorial (task demonstration, errors, scoring) and self-practiced to proficiency (no critical errors, < 2 min) using at-home suture kits (simple interrupted suture, instrument tie, penrose drain model). Optional virtual tutoring sessions were offered. Students submitted video performance for proficiency verification. Two sets of 14 videos were viewed by two surgeons until inter-rater reliability (IRR) was established. Students scoring "needs remediation" attended virtual remediation sessions. Non-parametric statistics were performed using RStudio. Results: All 229 medical students completed the curriculum within 1-4 h; 1.3% attended an optional tutorial. All videos were assessed 4.8% "exceeds expectations", 60.7% "meets expectations", and 34.5% "needs remediation." All 79 needing remediation due to critical errors achieved proficiency during 1-h group sessions. IRR Cohen's κ was 0.69 (initial) and 1.0 (ultimate). Task completion time was 56 (47-68) s (median [IQR]); p < 0.01 between all pairs. Students rated the overall curriculum (79.2%) and overall curriculum and video tutorial effectiveness (92.7%) as "agree" or "strongly agree". No definitive preference emerged regarding virtual versus in-person formats; however, 80.2% affirmed wanting other at-home skills curricula. Comments supported home practice as lower stress; remediation students valued direct formative feedback. Conclusions: A completely virtual 1-month knot-tying simulation is feasible and effective in achieving proficiency using video-based assessment and as-needed remediation strategies for a large student class.