The use of household items to support online surgical knot-tying skills training: a mixed methods study

This study investigated the perceptions and performance of medical students regarding their engagement and learning of a knot-tying skill presented in an online demonstration format due to the emergency remote measures that accompanied COVID-19 restrictions.

Final-year undergraduate medical students were invited to view an online demonstration of a one-handed knot-tying skill and practice the skill using common household items. They recorded their attempts and uploaded them onto the Flipgrid application. Completed attempts were scored using an adapted Objective Structured Assessment of Technical Skill (OSATS) validated tool. We used a mixed-methods sequential explanatory design; data regarding students' engagement was gathered via a short questionnaire, and a Focus Group Discussion (FGD) was conducted to understand their learning experiences better. Descriptive statistics such as proportions and percentages were used to summarize categorical variables and median for continuous variables. Each video attempt was scored independently by two surgeons; reliability was determined using intraclass correlation; statistical tests were conducted at a 5% level of significance. Responses to open-ended survey questions and qualitative data from the FGDs were analysed using thematic analysis.

Seventy-one students participated in the exercise. Most students (91.5%) expressed confidence in their ability to perform the skill and were able to follow the steps in the video demonstration (83.1%). Median number of times needed to practice before video submission was 7.0 (Interquartile range [IQR] 5.0-10.0). Using the adapted OSATS tool; median scores on student attempts were 19.0 out of 21 (IQR: 17.0-20.0) for Assessor 1 and 18.0 out of 21 (IQR: 17.0-20.0) for Assessor 2, and overall scores showed good reliability between assessors based on intraclass correlation (0.86, 95% CI 0.79-0.90, p < 0.001). Qualitative insights from the students' experiences in learning the skill were generally positive; it was a practical, experiential learning process and they valued the social aspects of learning via Flipgrid. Challenges expressed related to the need for in-person training and formal feedback on how to improve their technique. Suggestions to improve their learning included a request for an interactive session with immediate feedback on attempts, and being able to practice with a friend who would assist with videoing.

Basic knot-tying can be taught with acceptable efficiency and student satisfaction using online methods with items available at home.