Telementoring of Open and Laparoscopic Knot Tying and Suturing Is Possible: A Randomized Controlled Study

Aim Several motor learning models have been used to teach highly complex procedural skills in medical education. The aim of this randomized controlled trial was to assess the efficiency of telementoring of open and laparoscopic suturing of medical students compared to conventional in-person teaching and training. Methods After randomization, 23 medical students were assigned to either the telementoring or the in-person training group. Both groups were taught by surgically trained residence with a student–teacher ratio of 1:1 (teacher–student). Open suturing was assessed in a model of congenital diaphragmatic hernia and laparoscopic suturing in a model of bowel anastomosis. All subjects were trained according to the spaced learning concept for 3 hours. Primary end points were time, knot quality, precision, knot strength, and overall knotting performance/competency. Furthermore, we utilized the Surgery Task Load Index to evaluate the cognitive load of both teaching techniques. Students' subjective progress regarding skill acquisitions and acceptance of telementoring was assessed using a nine-item questionnaire. Results All 23 trainees significantly improved after training in all knot attributes. More than 90% of all subjects reached proficiency in both groups. In-person training and telementoring were similarly practical, and no significant differences regarding speed, knot quality, precision, knot stability, and procedure performance/competency were found. Students perceived no difference in acquisition of factual or applicational knowledge between the two groups. General acceptance of telementoring was moderate in both groups before training, but increased during training in students actually assigned to this group, in comparison to students assigned to conventional teaching. Conclusion The current study shows that telementoring of open and laparoscopic suturing is an ideal answer to the current coronavirus disease 2019 pandemic, ensuring continuous training. On-site training and telementoring are similarly effective, leading to substantial improvement in proficiency in intracorporeal suturing and knot tying. Likewise, students' subjective progress regarding skill acquisitions and cognitive load does not differ between teaching methods. Skepticism toward telementoring decreases after exposure to this learning method. Given our results, telementoring should be considered a highly effective and resource-saving educational approach even after the current pandemic.

The Use of Different Technological Methods for Teaching Basic Suturing Skills to Medical Students: A Literature Review

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.

Perceptions of medical students towards and effectiveness of online surgical curriculum: a systematic review

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.

TP8.2.19 Virtual versus In-Person Education Research (VIPER) in Surgical Skills Teaching: A crossover randomised controlled trial

Aims To compare effectiveness of virtual versus in-person teaching of one-handed reef knot to medical students. Methodology 20 students were randomised into 2 groups of 10, to learn to tie one-handed reef knot. Group A attended a 15-minute virtual session followed by a 15-minute in-person session; vice versa for Group B simultaneously. For the virtual session, trainer and students used online platform, Zoom, on an overhead webcam-laptop workstation in separate rooms. For the in-person session, trainer and students were in one room. Anonymous written feedback was collected from all students. Results 50% of the students had previous experience in knot-tying. On average, the instruction clarity and support received during the virtual session were reported to be less by Group A than Group B. 30% reported non-inferiority in the virtual method to in-person in fulfilling their training needs to learn this skill. 80% said they could have benefited from more time during the virtual session when compared to learning the same skill in-person. During the virtual sessions, 60% encountered technical difficulties relating to internet (20%), Zoom (25%), trainer availability (10%), and hardware (5%). 35% felt that a fully virtual session is suitable for learning one-handed reef knot. 30% stated they would attend a fully virtual basic surgical skills course whilst 40% would attend a partially virtual one. Conclusion Initial experience with virtual surgical skills teaching revealed promising potential based on student feedback. Further focused studies with targeted optimisation are warranted for it to be a viable alternative to traditional in-person teaching.

A new arthroscopic sliding locking knot: Banarji knot

Arthroscopic knot tying is a crucial component for a successful arthroscopic shoulder surgery. Knot tying should not be difficult to master or time consuming to perform. This study describes a new sliding locking knot for arthroscopic shoulder surgery and we named it Banarji knot, in the name of the author. It is a low profile, non-bulky, and double locking knot, which makes it a more secure knot.

SP10.2.7 Preparing foundation trainees for surgical on-calls

Foundation trainee feedback has highlighted low levels of confidence with the prospect of surgical oncalls. Key areas of concern are; assessing the acute surgical patient, identifying which patients need an operation and having the technical skills to competently assist in theatre. This lack of confidence prevents trainees engaging in an educational and rewarding rotation. We have designed and facilitated a day of robust workshops, addressing these key educational needs. Pre and post course questionnaires assessed the efficacy of teaching. Lectures on the assessment and management of acute surgical patients in general surgery, urology and trauma and orthopaedics were delivered by core surgical trainees. A named consultant oversaw these presentations to ensure quality assurance. Addressing the technical skills development need, an afternoon of surgical skills workshops covered; suturing, knot tying, laparoscopic principles and theatre etiquette. Small groups of trainees rotated through each workshop, delivered by senior specialty trainee registrars, to ensure high fidelity training. Trainees rated themselves in key areas pre and post course on a scale from 1-5. Pre course, 66% of trainees scored 3+ in “confidence in managing a surgical patient on-call”. This rose to 100% post course. Similarly; “Confidence in decision making regarding whether a patient should proceed to theatre” increased from 37.5% to 93.7%. “Suturing skills” improved from 37.5% to 100%. All trainees that attended the course displayed marked improvement in their confidence and competence. We feel this course or similar should be incorporated into the foundation teaching program locally and has scope to be expanded regionally.

SP10.2.2 Improving undergraduate surgical education: Comparing findings from the ASiT consensus report with the RCS Undergraduate Surgical Curriculum and GMC Outcomes for Graduates

Aims Previous work by ASiT has shown that undergraduate years can have a significant impact on the decision to pursue a surgical career. The Royal College of Surgeons England launched their recommendations in the undergraduate surgical curriculum in 2015. Our aim was to ascertain whether any additional areas of importance could be highlighted. Methods A consensus document was developed, using the RCS undergraduate surgical curriculum and GMC Outcomes for Graduates as baseline guides. An external advisory group made additional recommendations for inclusion which was then presented and discussed at a face-to-face consensus session at the 2019 ASiT International Surgical Conference. A consensus threshold of 80% was accepted. Results A total of 69 ‘core’ topics were reviewed and discussed, of which 10 did not reach consensus. These topics were predominantly considered to be ‘specialist’ in nature, and were under the domains of Head and Neck/ENT, neurosurgery, paediatric or vascular surgery. Of note, knot tying, which is included in the GMC guidance, was considered beyond the required level of a graduate and more suitable for those with the interest or intent to pursue a career in surgery. Conclusions Our consensus meeting and subsequent report has highlighted differences between the current available guidance and what medical students and junior doctors consider to be ‘core’ undergraduate surgical knowledge and skills. Topics that did not meet consensus may form areas of need in early postgraduate training. Our findings should be used in addition to the RCS and GMC guidance for undergraduate surgical education.

Estimation of time utilized in suturing of oral flaps post-surgical wisdom teeth removal using Negus knot pusher instrument (a comparative study)

Wisdom teeth were the most common teeth affected among the rest of the teeth, these teeth need accurate evaluation and diagnosis, surgical removal of impacted wisdom needs time for incision, bone removal and suture, so the use of any instrument helps to reduce this time is essential. Objective The objectives of this study were to estimate the time needed for the suture of oral flaps post-surgical removal of the lower wisdom teeth by using Negus knot pusher and compare it with the time used for stitching in conventional manual holding single stitching. Material and Methods: Data had been collected from thirty patients through history, clinical examination and radiographic assessment, followed by classical surgical removal performed on the same principles for all patients, at the suture level patients divided arbitrarily into two groups, control group 15 patients and 15 patients Negus pusher group, using Negus knot pusher, which is usually used to hold the stitch and stop bleeding post tonsillectomy operations by ligation, time elapsed for suturing with knot tying is calculated for both groups. Results: Among the 30 patients incorporated in the clinical study, control group mean was (1 minutes and 11 seconds and 70 milliseconds) while for the pusher group was (1 minutes and 32 seconds and 57 milliseconds), the comparison by means of T-test was not significant with the (0.424) value. Conclusion: the Negus pusher instrument can be used for the knotting stiches post wisdom teeth removal as an auxiliary tool and the time can be shortened by the use of a modified handling technique and more satisfaction for patients. Keywords Time; Suturing; Wisdom teeth; Negus knot pusher.