Pilot development with preliminary validation of a skills suturing score: essential suturing skills

Suturing skills are paramount for all surgeons. To date, there is no unified validated score that correlates with basic suturing abilities. We sought to develop and validate a score (Essential Suturing Skills-ESS) to evaluate basic suturing performance.

The ESS testing comprises two exercises. The applicant performs seven simple interrupted stitches in a dedicated foam base and follows with a running suture in a carpet-like material (seven throws). The time to perform the sutures and the surgical skills were compiled and combined through a novel mathematical equation, thus generating the ESS score. Fourth-year medical students (before and after 30 h of training), general surgery residents, and surgeons (control group) performed the ESS tasks. The evaluations were blinded. In the ESS score, a lower number indicates a better performance.

Sixty-two medical students (43 females), six general surgery residents, and eight surgeons have performed the ESS. The mean ESS score of the surgeons was 4.14 (± 0.45). The students had a 9.15 (± 2.10) ESS score before training and a 6.29 (± 0.98) after 30 h of training. The general surgery residents ESS score was (6.04 ± 0.91). The differences between the surgeons and students both before (p < 0.001) and after training were statistically significant (p < 0.0001). The improvement of the ESS score of the students after training was also significant (p < 0.0001). The residents had a similar performance compared with the students after training (p = 0.536) and significantly worse compared with the professors (p = 0.0002). Each evaluation took about 20 min to be completed.

In this pilot validation study, the ESS score correlated well with suturing performance, with clear discrimination between medical students, residents, and surgeons. It is low cost and simple to perform and evaluate. Future developments include a pass/fail score, cognitive testing, and automated evaluation.