Madeline Lemke, Hillary Lia, Alexander Gabinet-Equihua, Guy Sheahan, Andrea Winthrop, Stephen Mann, Gabor Fichtinger, Boris Zevin. Queen’s University
Background: Suturing is a fundamental skill in undergraduate medical education. It can be taught by faculty-led, peer-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-led, and holography augmented proficiency-based suturing training to 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, incremental costs incurred. Participant preferences were surveyed.
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 (Table 1). The computer-augmented method was costlier 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 computer-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: Proficiency-based teaching of suturing using faculty-led and peer tutor-led instructional methods were superior to holography-augmented method with respect to costs and participants’ preferences despite being educationally equivalent.
Table 1. Outcomes
| All (n=44) | Faculty-led (n=16) | Peer tutor-led (n=14) | Holography augmented (n=14) | |
| Number of sutures placed P=0.376 | 90.3(55.6) | 80.0(47.2) | 85.0(58.6) | 107.4(61.3) |
| Number of full-length sutures used P=0.735 | 10.1(6.0) | 9.3(5.3) | 10.3(7.0) | 11.0(6.0) |
| Time to proficiency (minutes) P=0.390 | 174.3(100.3) | 158.1(89.2) | 162.2(98.9) | 205.0(113.2) |
| Incremental cost per particpant (CAD) P<0.001* | $209.28($50.37) | $200.11($60.19) | $182.05($40.42) | $247.00($12.05) |
All values are reported as mean(standard deviation); *P-values<0.05 is considered statistically significant.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93953
Program Number: P379
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster