SUTURE TRAINING SIMULATION PRIOR TO MEDICINE ELECTIVE IN MEDICAL STUDENTS: A RANDOMIZED CONTROLLED TRIAL

Martin Inzunza, MD, Rodrigo Tejos, MD, Emma Alexander, Jose Quezada, MD, Ruben Avila, MD, Nicolas Jarufe, MD, Julian Varas, MD, Pablo Achurra, MD. Pontificia Universidad Católica de Chile

INTRODUCTION: In Chile, medical students have the opportunity to undertake a month-long Medicine Elective (ME) in a community hospital, primary care center or emergency department within the country at the end of their first clinical year. Due to the lack of opportunities to practice suturing in the first years, students usually do not have an optimal performance in this type of medical procedure during the ME. Simulation training programs in suturing improve technical skills, self-confidence and patient safety in the medical internship. The objective of this study is to evaluate the impact of implementing a simulated suture training program earlier in the medical curriculum, before the ME.

METHODS: We conducted a prospective, randomized controlled trial with 50 medical students at the end of their first clinical year. They were randomized into two equal groups. The intervention group received an intensive suture training program consisting in one theory class, four practical sessions and effective feedback from an expert surgeon. The control group did not receive training, remaining with the classic opportunistic learning approach during the ME. After the ME, all students undertook an electronic survey. Statistical analysis was performed on the answers of both groups. Per protocol analysis was applied.

RESULTS: There were no statistical differences between groups in terms of age and sex. Four students did not complete the training program. One student in the control group did not reply to the survey. Higher self-confidence with regards to suturing was reported in the intervention group in comparison with the control group [10/21(48%) vs 4/29(14%), p<0,001]. Also, a greater student desire to carry out suture-related procedures was reported in the intervention group than the control group [16/21(76%) vs 11/29(38%), p<0,001]. In addition, a lower rate of overseeing physician intervention was reported in the intervention group [3/21(14%) vs 14/29(48%), p<0,001] (Table 1). A greater number of patients requiring sutures were treated by the intervention group than the control group, with a median of 4 patients (3-7) against 2 (1-4). The intervention group performed a higher number of sutures with a median of 17 (6-31) vs 7 (2-16), with a statistically significant difference (p<0,05) in both cases (Figure 1).

CONCLUSION: A simulated suture training program prior to the ME generates a positive impact on medical students by improving self-confidence and desire to attend patients that require sutures. This leads to a higher rate of both exposure to suture techniques and suture execution.