Vol. 21 No. 1 (2023)
Research Article

Teaching Medical Students to Suture: Evaluation of a Modern Medical School Curriculum

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  • Chantell Cleversey,
  • Alexander Rebchuk,
  • Riley Reel,
  • Graeme Hintz,
  • Pedram Laghaei Farimani,
  • Adrian Yee
Chantell Cleversey
Division of Indigenous Family Medicine, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
Bio
Alexander Rebchuk
Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
Bio
Riley Reel
Undergraduate Medical Education, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
Bio
Graeme Hintz
Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
Bio
Pedram Laghaei Farimani
Undergraduate Medical Education
Bio
Adrian Yee
Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
Bio
Stitches of a baseball
DOI: https://doi.org/10.26443/mjm.v21i1.949

Published 2022-11-08

Keywords

  • Suturing,
  • Education,
  • Curricula,
  • Medical Students

How to Cite

1.
Cleversey C, Rebchuk A, Reel R, Hintz G, Laghaei Farimani P, Yee A. Teaching Medical Students to Suture: Evaluation of a Modern Medical School Curriculum. McGill J Med [Internet]. 2022 Nov. 8 [cited 2025 Oct. 6];21(1). Available from: https://mjm.mcgill.ca/article/view/949

Copyright (c) 2022 Chantell Cleversey, Alexander Rebchuk, Riley Reel, Graeme Hintz, Pedram Laghaei Farimani, Adrian Yee

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This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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Abstract

Background: Medical students are traditionally introduced to suturing in a simulated environment using animal products or synthetic materials. However, there is little evidence to support this pedagogy. Our study explored whether a modern suturing curriculum adequately prepares medical students and examined   student preference for learning suturing skills.

 

Methods: Suturing performance was recorded and assessed by expert raters. Students also completed a survey that inquired about self-perceived knowledge and confidence in suturing, and preferred pedagogical methods.

 

Results: The majority (79%) of students that completed our suturing curriculum demonstrated competence in basic suturing techniques. There was no correlation between objective abilities and self-perceived knowledge or confidence. Students reported being significantly more confident suturing anesthetized patients and in simulated environments. Students reported a desire for earlier introduction to suturing and more frequent simulation training.

 

Conclusion: A modern medical school suturing curriculum, comprising online modules and in-person simulation-based learning, adequately develops basic suturing techniques.

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References

  1. Routt E, Mansouri Y, de Moll EH, Bernstein DM, Bernardo SG, Levitt J. Teaching the Simple Suture to Medical Students for Long-term Retention of Skill. JAMA Dermatol [Internet]. 2015 Jul [cited 2021 Dec 12];151(7):761-765. Available from: https://doi.org/10.1001/jamadermatol.2015.118
  2. Barnes RW. Surgical handicraft: Teaching and learning surgical skills. Am J Surg [Internet]. 1987 May [cited 2021 Dec 12];153(5):422-427. Available from: https://doi.org/10.1016/0002-9610(87)90783-5
  3. Ericsson KA, Krampe RT, Tesch-Römer C. The role of deliberate practice in the acquisition of expert performance. Psychol Rev [Internet]. 1993 [cited 2021 Dec 12];100(3):363-406. Available from: https://doi.org/10.1037/0033-295X.100.3.363
  4. Morgan PJ, Cleave-Hogg D. A Canadian simulation experience: faculty and student opinions of a performance evaluation study. Br J Anaesth [Internet]. 2000 Nov [cited 2022 Mar 14];85(5):779-781. Available from: https://doi.org/10.1093/bja/85.5.779
  5. Logue ME, Lurtsema RD, Leyva Y, Hough TJ, Harrington KM, Mercer DM. Suturing Workshop for Third-Year Medical Students: A Modern Educational Approach. UNM Orthop Res J [Internet]. 2017 [cited 2021 Dec 12];6(1):27. Available from: https://digitalrepository.unm.edu/unm_jor/vol6/iss1/27
  6. Lenchus JD. End of the “see one, do one, teach one” era: the next generation of invasive bedside procedural instruction. J Am Osteopath Assoc [Internet]. 2010 Jun [cited 2021 Dec 12];110(6):340-346. Available from PubMed: https://pubmed.ncbi.nlm.nih.gov/20606241
  7. Hamaoui K, Saadeddin M, Sadideen H. Surgical skills training: time to start early. Clin Teach [Internet]. 2014 May [cited 2021 Dec 12];11(3):179-183. Available from: https://doi.org/10.1111/tct.12128
  8. Sadideen H, Kneebone R. Practical skills teaching in contemporary surgical education: how can educational theory be applied to promote effective learning? Am J Surg [Internet]. 2012 Sep [cited 2021 Dec 12];204(3):396-401. Available from: https://doi.org/10.1016/j.amjsurg.2011.12.020
  9. Khunger N, Kathuria S. Mastering surgical skills through simulation-based learning: practice makes one perfect. J Cutan Aesthet [Internet]. 2016 Jan-Mar [cited 2021 Dec 12];9(1):27. Available from: https://doi.org/10.4103/0974-2077.178540
  10. Manning EP, Mishall PL, Weidmann MD, Flax H, Lan S, Erlich M, Burton WB, Olson TR, Downie SA. Early and prolonged opportunities to practice suturing increases medical student comfort with suturing during clerkships: Suturing during cadaver dissection. Anat Sci Educ [Internet]. 2018 Mar [cited 2021 Dec 12];11(6):605-612. Available from: https://doi.org/10.1002/ase.1785
  11. DiMaggio PJ, Waer AL, Desmarais TJ, Poskus DM, Tatum J, Adamas-Rappaport WJ. The use of a lightly preserved cadaver and full thickness pig skin to teach technical skills on the surgery clerkship—a response to the economic pressures facing academic medicine today. Am J Surg [Internet]. 2010 Jul [cited 2021 Dec 12];200(1):162-166. Available from: https://doi.org/10.1016/j.amjsurg.2009.07.039
  12. Böckers A, Lippold D, Fassnacht U, Schelzig H, Böckers TM. Ready for the OR? – Clinical anatomy and basic surgical skills for students in their preclinical education. GMS Z Med Ausbild [Internet]. 2011 Aug [cited 2021 Dec 12];28(3). Available from: https://doi.org/10.3205/zma000757
  13. Böckers A, Mayer C, Böckers TM. Does learning in clinical context in anatomical sciences improve examination results, learning motivation, or learning orientation? Anat Sci Educ [Internet]. 2014 Jun [cited 2021 Dec 12];7(1):3-11. Available from: https://doi.org/10.1002/ase.1375
  14. Boyajian MK, Lubner RJ, Roussel LO, Crozier JW, Ryder BA, Woo AS. A 3D printed suturing trainer for medical students. Clin Teach [Internet]. 2020 Dec [cited 2022 Mar 14];17(6):650-654. Available from: https://doi.org/10.1111/tct.13176
  15. Olasky J, Kim M, Muratore S, Zhang E, Fitzgibbons SC, Campbell A, Acton R. ACS/ASE Medical Student Stimulation-Based Skills Curriculum Study: Implementation Phase. J Surg Educ [Internet]. 2019 Aug [cited 2022 Mar 14];76(4):962-969. Available from https://doi.org/10.1016/j.jsurg.2019.01.014
  16. Pender C, Kiselov V, Yu Q, Mooney J, Greiffenstein P, Paige JT. All for knots: evaluating the effectiveness of a proficiency-driven, simulation-based knot tying and suturing curriculum for medical students during their third-year surgery clerkship. Am J Surg [Internet]. 2017 Feb [cited 2022 Mar 14];213(2):362-370. Available from: https://doi.org/10.1016.j.amjsurg.2016.06.028
  17. Pernar LIM, Smink DS, Hicks G, Peyre SE. Residents can successfully teach basic surgical skills in the simulation center. J Surg Educ [Internet]. 2012 Oct [cited 2022 Mar 14];69(5):617-622. Available from: https://doi.org/10.1016.j.jsurg.2012.03.001
  18. Martin JA, Regehr G, Reznick R, Macrae H, Murnaghan J, Hutchison C, Brown M. Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg [Internet]. 2005 Dec [cited 2021 Dec 12];84(2):273-278. Available from: https://doi.org/10.1046/j.1365-2168.1997.02502.x
  19. Chipman JG, Schmitz CC. Using objective structured assessment of technical skills to evaluate a basic skills simulation curriculum for first-year surgical residents. J Am Coll Surg [Internet]. 2009 Sep [cited 2021 Dec 12];209(3):364–370. Available from: https://doi.org/10.1016/j.jamcollsurg.2009.05.005
  20. Fergusson SJ, Sedgwick DM, Ntakiyiruta G, Ntirenganya F. The basic surgical skills course in Sub-Saharan Africa: An observational study of effectiveness. World J Surg [Internet]. 2017 Oct [cited 2021 Dec 12];42(4):930–936. Available from: https://doi.org/10.1007/s00268-017-4274-2
  21. Cohen J. A power primer. Psychol Bull [Internet]. 1992 [cited 2021 Dec 12];112(1):155–159. Available from: https://doi.org/10.1037/0033-2909.112.1.155
  22. Ogden J, Fuks K, Gardner M, Johnson S, McLean M, Martin P, Shah R. Doctors expressions of uncertainty and patient confidence. Patient Educ Couns [Internet]. 2002 Feb [cited 2021 Dec 12];48(2):171-176. Available from: https://doi.org/10.1016/S0738-3991(02)00020-4
  23. Berner E, Graber M. Overconfidence as a cause of diagnostic error in medicine. Am J Med [Internet]. 2008 May [cited 2021 Dec 12];121(5):S2-S23. Available from: https://doi.org/10.1016/j.amjmed.2008.01.001
  24. Saposnik G, Redelmeier D, Ruff CC, Tobler PN. Cognitive biases associated with medical decisions: a systematic review. BMC Med Inform Decis Mak [Internet]. 2016 Nov [cited 2021 Dec 12];16(1):138. Available from: https://doi.org/10.1186/s12911-016-0377-1
  25. Graber ML, Kissam S, Payne VL, Meyer AND, Sorensen A, Lenfestey N, Tant E, Henriksen K, LaBresh K, Singh H. Cognitive interventions to reduce diagnostic error: a narrative review. BMJ Qual Saf [Internet]. 2012 Apr [cited 2021 Dec 12];21(7):535–57. Available from: https://doi.org/10.1136/bmjqs-2011-000149
  26. Crikelair GF. Skin suture marks. Am J Surg [Internet]. 1958 Nov [cited 2021 Dec 12];96(5):631-639. Available from: https://doi.org/10.1016/0002-9610(58)90464-1
  27. De S, Rosen J, Dagan A, Hannaford B, Swanson P, Sinanan M. Assessment of tissue damage due to mechanical stresses. Int J Robot [Internet]. 2007 Nov [cited 2021 Dec 12];26(11-12):1159-1171. Available from: https://doi.org/10.1177/0278364907082847
  28. Cervini P, Bell C. Brief report: Needlestick injury and inadequate post-exposure practice in medical students. J Gen Intern Med [Internet]. 2005 May [cited 2021 Dec 12];20(5):419-421. Available from: https://doi.org/10.1111/j.1525-1497.2005.0092.x
  29. Varsou O, Lemon JS, Dick FD. Sharps injuries among medical students. J Occup Med [Internet]. 2009 Oct [cited 2021 Dec 12];59(7):509-11. Available from: https://doi.org/10.1093/occmed/kqp103
  30. Naylor RA, Hollett LA, Valentine RJ, Mitchell IC, Bowling MW, Moe Ma A, Dineen SP, Bruns BR, Scott DJ. Can medical students achieve skills proficiency through simulation training? Am J Surg [Internet]. 2009 Apr [cited 2021 Dec 12];198(2):277-282. Available from: https://doi.org/10.1016/j.amjsurg.2008.11.036
  31. Ziv A, Ben-David S, Ziv M. Simulation based medical education: An opportunity to learn from errors. Med Teach [Internet]. 2009 Jul [cited 2021 Dec 12];27(3):193-199. Available from: https://doi.org/10.1080/01421590500126718
  32. Pavlidis I, Zavlin D, Khatri AR, Wesley A, Panagopoulos G, Echo A. Absence of stressful conditions accelerates dexterous skill acquisition in surgery. Sci Rep [Internet]. 2019 Feb [cited 2021 Dec 12];9(1):1747. Available from: https://doi.org/10.1038/s41598-019-38727-z
  33. Kachare SD, Kapsalis C, Yun A, Kachare MD, Davis J, Weeks D, Jhang J, Wilhelmi BJ, Kasdan ML. Students teaching students: A survey of a medical student led surgical skills workshop - A prospective cohort study. Ann Med Surg (Lond) [Internet]. 2020 May [cited 2021 Dec 12];56:43-47. Available from: https://doi.org/10.1016/j.amsu.2020.05.034
  34. Malpas PJ, Bagg W, Yielder J, Merry AF. Medical students, sensitive examinations and patient consent: A qualitative review. N Z Med J [Internet]. 2018 Sep [cited 2021 Dec 12];131(1482):29-37. Available from: https://www-nzma-org-nz.ezproxy.library.ubc.ca/journal-articles/medical-students-sensitive-examinations-and-patient-consent-a-qualitative-review
  35. Coldicott Y, Pope C, Roberts C. The ethics of intimate examinations: Teaching tomorrow's doctors. BMJ [Internet]. 2003 Jan [cited 2021 Dec 12];326(7380):97-99. Available from: https://doi.org/10.1136/bmj.326.7380.97
  36. Ubel PA, Jepson C, Silver-Isenstadt A. Don't ask, don't tell: A change in medical student attitudes after obstetrics/gynecology clerkships toward seeking consent for pelvic examinations on an anesthetized patient. Am J Obstet Gynecol [Internet]. 2003 Feb [cited 2021 Dec 12];188(2):575-579. Available from: https://doi.org/10.1067/mob.2003.85
  37. Friesen P. Educational pelvic exams on anesthetized women: Why consent matters. Bioeth [Internet]. 2018 Apr [cited 2021 Dec 12];32(5):298-307. Available from: https://doi.org/10.1111/bioe.12441
  38. Safir O, Williams CK, Dubrowski A, Backstein D, Carnahan H. Self-directed practice schedule enhances learning of suturing skills. Can J Surg [Internet]. 2013 Dec [cited 2021 Dec 12];56(6):E142-E147. Available from: https://doi.org/10.1503/cjs.019512
  39. Hatala R, Cook DA, Brydges R, Hawkins R. Constructing a validity argument for the Objective Structured Assessment of Technical Skills (OSATS): a systematic review of validity evidence. Adv Health Sci Educ Theory Pract [Internet]. 2015 Dec [cited 2022 Mar 14];20(5):1149-1175. Available from: https://doi.org/10.1007/s10459-015-9593-1
  40. Sundhagen HP, Almeland SK, Hansson E. Development and validation of a new assessment tool for suturing skills in medical students. Eur J Plast Surg [Internet]. 2018 May [cited 2021 Dec 12];41(2):207-216. Available from: https://doi.org/10.1007/s00238-017-1378-8