scholarly journals Comparison of knot-tying proficiency and knot characteristics for square and reversing half hitch alternating-post surgical knots in a simulated deep body cavity among novice medical students

2018 ◽  
Vol 61 (6) ◽  
pp. 385-391
Author(s):  
Vincent Wu ◽  
Cynthia Yeung ◽  
Edward A. Sykes ◽  
Boris Zevin

2021 ◽  
Vol 64 (1) ◽  
pp. E59-E65
Author(s):  
Edward A. Sykes ◽  
Madeline Lemke ◽  
Daniel Potter ◽  
Terry Li ◽  
Zuhaib M. Mir ◽  
...  

Background: Square knots can be difficult to construct in deep body cavities. The reversing half-hitch alternating post (RHAP) surgical knot has noninferior tensile strength and performance characteristics in deep body cavities. We compared the enterotomy repairs of novice learners in simulated deep body cavities using RHAP versus square knots after proficiency-based training. Methods: Undergraduate students were randomized to RHAP (n = 10) or square knot (n = 10) groups and trained to defined proficiency. They then performed hand-sewn enterotomy repairs of cadaveric porcine small bowels on flat surfaces and in simulated deep body cavities. We recorded time to knot-tying proficiency and to enterotomy repair, and burst pressures for the repair. Results: Mean time-to-proficiency in knot tying was equivalent between the RHAP and square knot groups (23 [standard deviation (SD) 3] v. 21 [SD 2] min, p = 0.33). Mean time for enterotomy repair in deep cavities was shorter for the RHAP group (16 [SD 2] min v. 21 [SD 1] min, p = 0.02). Mean burst pressures for enterotomy repair were equivalent on flat surfaces (128 [SD 41] v. 101 [SD 36] mm Hg, p = 0.31), and were significantly higher for the RHAP group in simulated deep body cavities (32 [SD 13] v. 105 [SD 37] mm Hg, p = 0.05). Conclusion: The RHAP knots appear to have superior performance versus square knots when tied in a deep body cavity by novice learners. Future work should focus on demonstrating the clinical relevance and broad utility of the RHAP knot in abdominal surgery. Both knot types should be taught to novice learners.



2021 ◽  
pp. 155335062110035
Author(s):  
Brian R Quaranto ◽  
Michael Lamb ◽  
John Traversone ◽  
Jinwei Hu ◽  
James Lukan ◽  
...  

Introduction. Teaching surgical skills has historically been a hands-on activity, with instructors and learners in close physical proximity. This paradigm was disrupted by the COVID-19 pandemic, requiring innovative solutions to surmount the challenges of teaching surgical skills remotely. In this work, we describe our institution’s path and early results of developing an interactive remote surgical skills course for medical students in the surgical clerkship. Methods. 31 third-year medical students were distributed a set of surgical equipment and 3D printed phone dock. Each participant completed a baseline questionnaire and underwent 3 structured interactive remote sessions on surgical instruments, knot tying, and suturing techniques. Students were instructed on sharing their first-person viewpoint and received real-time feedback on their knot tying and suturing techniques from the course instructor. Pre- and post-session surveys were conducted and analyzed. Results. All students were able to complete the remote surgical skills course successfully, as defined by visually demonstrating successful two-handed knot and simple suture techniques. Students’ aggregate confidence score in their knot tying ability (pretest mean 7.9, SD 0.7 vs posttest mean 9.7, SD 0.9, t-statistic −2.3, P = .03) and suturing ability (pretest mean 8.0, SD 1.3 vs posttest mean 13.8, SD 0.9 t-statistic −5.5, P < .001) significantly improved after the intervention. Qualitative feedback from the students underscored the utility of the first-person perspective for teaching surgical technique. Conclusion. This study demonstrates that remote teaching of knot tying and simple suturing to medical students can be effectively implemented using a remote learning curriculum that was well received by the learners.



2005 ◽  
Vol 71 (12) ◽  
pp. 1018-1023 ◽  
Author(s):  
Kent R. Van Sickle ◽  
Brittany Smith ◽  
David A. McClusky ◽  
Mercedeh Baghai ◽  
C. Daniel Smith ◽  
...  

Training and assessment methods for knot tying by medical students or residents have traditionally been subjective. Objective methods for evaluating creation of a tied knot should include assessing the strength and quality of the knotted suture. The purpose of this study was to evaluate the use of a tensiometer as a feedback device for improving knot-tying performance. Twelve medical students with no knot-tying experience were selected to perform three-throw instrument ties with 00 silk suture. Students were randomly assigned to perform between 10 and 20 baseline knots and then received one of four feedback training conditions followed by 10 completion knots. Subjects were timed, and all knots were pulled in the tensiometer to assess for strength and slippage. Differences between baseline and completed knots for each subject were analyzed with an unpaired t test. Subjects receiving both subjective and tensiometer feedback demonstrated the greatest improvements in knot quality score (KQS) and slip percentage (Subject 1: 0.15 ± 0.9 vs 0.21 ± 0.05, P < 0.04, 75% vs 60%, P = NS; Subject 2: 0.22 ± 0.10 vs 0.29 ± 0.05, P < 0.02, 33% vs 0%, P < 0.05; Subject 3: 0.10 ± 0.07 vs 0.25 ± 0.07, P < 0.0001, 60% vs 10%, P < 0.01). Objective assessment of knot-tying performance is possible using the tensiometer device. Introduction of the tensiometer during the learning phase produced improved KQS and slip percentage in most students regardless of the number of baseline knots tied. Greatest improvements in performance were seen when the tensiometer was used in combination with subjective instruction.



2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shye-Jao Wu ◽  
Ya-Fen Fan ◽  
Shen Sun ◽  
Chen-Yen Chien ◽  
Yih-Jer Wu

Abstract Background Online education has been used as an adjunct modality for teaching and it attracts attention in recent years as many medical students can not accomplish their clerkship in the hospital due to COVID-19 pandemic. This study aims to collect the articles related to online surgical education for medical students, and to analyze the effectiveness of online education and the perceptions of the medical students. Method We performed a systemic literature search in PubMed, MEDLINE, EMBASE, ERIC and Cochrane library. Keywords used for searching included “medical student”, “online education”, “online teaching”, “online learning”, “distance learning”, “electronic learning”, “virtual learning” and “surgical”. Medical education research study quality instrument (MERSQI) was used for the evaluation of the quality of the searched articles. Results From 1240 studies retrieved from the databases, 13 articles were included in this study after screening. The publication year was from 2007 to 2021. The mean MERSQI score of the 13 searched articles was 12.5 +/− 1.7 (range 10.0-14.5). There were totally 2023 medical students who attended online surgical curriculum. By online course, improvement of understanding and knowledge on the studied topics could be reached. The confidence in patient encounters could be improved by online curriculum with sharing experiences, discussing, and role playing. However, students felt concentration was poor during online course. Medical students studying through video platform could get better test scores than those studying with textbooks. Regarding basic surgical skills, online teaching of suturing and knot-tying could be possible and was appreciated by the students who could practice away from the hospital and get feedbacks by instructors through online environment. The scores for the clinical competence assessment for incision, suturing and knot-tying were found to be no significant difference between the online teaching group and face-to-face teaching group. Conclusion Online surgical curriculum for medical students is not easy but inevitable in the era of COVID-19 pandemic. Although online course is not the same as physical course, there are some efforts which could be tried to increase the effectiveness. Basic surgical skills could also be taught effectively through online platform. Even if the COVID-19 pandemic is over in the future, online curriculum could still be a helpful adjunct for surgical education.



Surgery ◽  
2007 ◽  
Vol 141 (4) ◽  
pp. 442-449 ◽  
Author(s):  
George J. Xeroulis ◽  
Jason Park ◽  
Carol-Anne Moulton ◽  
Richard K. Reznick ◽  
Vicki LeBlanc ◽  
...  




2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R Galloway ◽  
H Amar ◽  
V Panchalingham

Abstract Introduction Limited theatre exposure, cancelled practical teaching and placements abandoned due to COVID-19, has potential to damage the learning opportunities and experiences of medical students within surgery. We aimed to create and deliver an emergency small group teaching programme throughout the pandemic, targeted at increasing medical student confidence in basic surgical skills and inspiring interest in surgery. Method Multiple small-group teaching sessions were delivered to a cohort of 14 medical students recruited for work during the pandemic, whilst adhering to social distancing and sanitary measures. On completion of the programme and informal assessment of 11 surgical competencies, participants completed a follow up questionnaire to assess their improvement. Results 70% reported improvement in 10 competencies and 30% across all 11 competencies. The greatest improvements were in abscess drainage and knot tying. 30% relayed increased interest in pursuing a surgical career. 80% were ‘more likely’ to attend theatres in future. Conclusions The teaching series facilitated increase in self-perceived confidence of students in basic surgical skills, whilst inspiring surgical interests. During challenging times, we must support learners to undertake activity that drives improvement in training for the wider benefit of health services. Innovative teaching programmes may reduce the impact of similar adversity in the future.



2021 ◽  
Vol 13 (4) ◽  
pp. 1-18
Author(s):  
Helen Xinyi Cai ◽  
◽  
Sarah Yew ◽  
Qi Rou Yap ◽  
Sherry Seah ◽  
...  

Suturing skills are usually acquired by medical students through observation and then practice. There is a pressing need to develop more efficient teaching methods as students are often unprepared to perform suturing in clinical practice. This study therefore aims to investigate the benefits and limitations of different technological teaching methods and determine if technological methods are superior to conventional teaching. The search was conducted using ScienceDirect, PubMed and Scopus with different combinations of the key terms “suturing”, “suture”, “knot-tying”, “suturing skill”, “surgical skill”, “teaching methods” and “medical students”. Overall, 19 relevant articles were shortlisted, discussing the use of virtual reality, augmented reality, videos and programmes in teaching suturing skills. The use of instructional videos is a good alternative to the traditional lab-based method while video self-reflection was found to be an effective enhancement. Integration of these methods could be a valuable addition to the current curriculum.



2021 ◽  
Vol 13 (02) ◽  
pp. e234-e241
Author(s):  
Joshua Cole ◽  
Tiffany A. Chen ◽  
Tessnim Ahmad ◽  
Neeti Parikh

Abstract Objective This study aimed to evaluate the impact of an ophthalmic microsurgery laboratory on medical students' intrinsic motivation, explicit interest in ophthalmology, and comfort with microsurgical skills. Design In this noncontrolled trial, medical students attended a Zoom-based lecture on corneal suturing, watched an instructional video on operating microscopes, and attended a wet laboratory on corneal suturing. Participants completed pre- and posttest surveys assessing comfort with microsurgical skills and explicit interest in ophthalmology. Additionally, the posttest survey included items from the Intrinsic Motivation Inventory (IMI). Setting This study was conducted at a single academic medical center. Participants A total of 20 students enrolled in the MD program at the University of California, San Francisco School of Medicine. Results Pre- and posttest response rates were 100% (n = 20) and 90% (n = 18), respectively. Comfort with microsurgical skills increased significantly between pre- and posttest surveys with large effect sizes (95% confidence interval [CI]; p-value): loading a needle, 1.67 (1.04–2.29; p < 0.001); passing a suture, 1.72 (1.04–2.40; p < 0.001); knot tying, 1.05 (0.34–1.76; p = 0.004); using a microscope, 0.83 (0.04–1.63; p = 0.040); and suturing under a microscope, 1.44 (0.88–2.00; p < 0.001). Comparing pre- and posttest surveys, students reporting moderate to extreme interest in ophthalmology increased from 44 to 61%. Intrinsic motivation was high, indicated by the mean IMI Interest score reaching 93% of the maximum score. Multiple linear regression analyses predicted that IMI Interest scores increased with higher scores of familiarity (p = 0.002), explicit interest in ophthalmology (p = 0.042), and comfort with microscopes (p = 0.005), knot tying (p = 0.026), and performing surgical maneuvers under a microscope (p = 0.032). Conclusion Ophthalmic microsurgery laboratories may increase medical students' explicit interest in ophthalmology, comfort with microsurgical skills, and intrinsic motivation. Future studies are needed to evaluate the impact of microsurgical electives on students' objective skills and specialty selection.



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