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Year one outcomes assessment of a masters suturing and knot-tying program for surgical interns
Matthew Schill1, Debbie Tiemann, Mary E Klingensmith
1Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Purpose:
We implemented and evaluated the outcomes of a proficiency-based program to enhance basic suturing and knot-tying skills in surgical interns.
Methods:
A suturing and knot-tying "masters program" was implemented for 9 surgical interns. Assessment consisted of timed and videotaped technical performance (TP) of 6 suturing (simple interrupted, subcuticular, and vertical mattress) and tying tasks (1-handed, 2-handed, and tie on pass) preinstruction (baseline) and at 4 months. Feedback and remediation were done after 4 months, and interns were retested until goals were met. TP was scored on a 1-5 scale (1 = novice, 3 = proficient, and 5 = expert). The results were compared with 6 end of PGY2 year residents and rotation evaluations, case numbers, and American Board of Surgery In-Training Examination (ABSITE) scores. The data are mean ± standard deviation (SD); statistical analysis was by 1-way ANOVA, Kruskal-Wallis test, and Pearson correlation.
Results:
The total combined task times improved significantly from initial (1289 ± 301 seconds) to final assessment (770 ± 139 seconds, p = 0.0003) and between 4-month assessment (1092 ± 253 seconds) and final assessment (p = 0.0237), but not baseline to 4-month assessment (p = 0.213). Final TP scores were improved significantly (baseline, 1.87 ± 0.81; 4-month assessment, 2.63 ± 0.75; and final assessment 3.51 ± 0.39 [p < 0.001]. All interns reached proficiency on 6/6 tasks but not until 10.1 months (range, 4-12 months) and 2.4 assessment sessions (range, 1-3). No significant differences in final total task times or TP scores were found between interns (770 ± 139 seconds and TP, 3.51 ± 0.39) and end of PGY-2 residents (677 ± 109 seconds and TP, 3.6 ± 0.43). The total task time and rotation technical comments were associated significantly, but TP scores, case numbers, and ABSITE scores were not.
Conclusions:
Training, feedback, and remediation are necessary to reach proficiency in basic suturing and knot tying. This program provides an objective assessment of interns' skills not discernible by conventional measures.
