Optimizing resource utilization during proficiency-based training of suturing skills in medical students: a randomized controlled trial of faculty-led, peer tutor-led, and holography-augmented methods of teaching.

BACKGROUND: Suturing is a fundamental skill in undergraduate medical education. It can be taught by faculty-led, peer tutor-led, and holography-augmented methods; however, the most educationally effective and cost-efficient method for proficiency-based teaching of suturing is yet to be determined. METHODS: We conducted a randomized controlled trial comparing faculty-led, peer tutor-led, and holography-augmented proficiency-based suturing training in pre-clerkship medical students. Holography-augmented training provided holographic, voice-controlled instructional material. Technical skill was assessed using hand motion analysis every ten sutures and used to construct learning curves. Proficiency was defined by one standard deviation within average faculty surgeon performance. Intervention arms were compared using one-way ANOVA of the number of sutures placed, full-length sutures used, time to proficiency, and incremental costs incurred. Surveys were used to evaluate participant preferences. RESULTS: Forty-four students were randomized to the faculty-led (n = 16), peer tutor-led (n = 14), and holography-augmented (n = 14) intervention arms. At proficiency, there were no differences between groups in the number of sutures placed, full-length sutures used, and time to achieve proficiency. The incremental costs of the holography-augmented method were greater than faculty-led and peer tutor-led instruction ($247.00 ± $12.05, p < 0.001) due to the high cost of the equipment. Faculty-led teaching was the most preferred method (78.0%), while holography-augmented was the least preferred (0%). 90.6% of students reported high confidence in performing simple interrupted sutures, which did not differ between intervention arms (faculty-led 100.0%, peer tutor-led 90.0%, holography-augmented 83.3%, p = 0.409). 93.8% of students felt the program should be offered in the future. CONCLUSION: Faculty-led and peer tutor-led instructional methods of proficiency-based suturing teaching were superior to holography-augmented method with respect to costs and participants' preferences despite being educationally equivalent.

Comparison of Personal Video Technology for Teaching and Assessment of Surgical Skills.

BACKGROUND: Improvements in personal technology have made video recording for teaching and assessment of surgical skills possible. OBJECTIVE: This study compared 5 personal video-recording devices based on their utility (image quality, hardware, mounting options, and accessibility) in recording open surgical procedures. METHODS: Open procedures in a simulated setting were recorded using smartphones and tablets (MOB), laptops (LAP), sports cameras such as GoPro (SC), single-lens reflex cameras (DSLR), and spy camera glasses (SPY). Utility was rated by consensus between 2 investigators trained in observation of technology using a 5-point Likert scale (1, poor, to 5, excellent). RESULTS: A total of 150 hours of muted video were reviewed with a minimum 1 hour for each device. Image quality was good (3.8) across all devices, although this was influenced by the device-mounting requirements (4.2) and its proximity to the area of interest. Device hardware (battery life and storage capacity) was problematic for long procedures (3.8). Availability of devices was high (4.2). CONCLUSIONS: Personal video-recording technology can be used for assessment and teaching of open surgical skills. DSLR and SC provide the best images. DSLR provides the best zoom capability from an offset position, while SC can be placed closer to the operative field without impairing sterility. Laptops provide best overall utility for long procedures due to video file size. All devices require stable recording platforms (eg, bench space, dedicated mounting accessories). Head harnesses (SC, SPY) provide opportunities for "point-of-view" recordings. MOB and LAP can be used for multiple concurrent recordings.