An Objective Assessment Tool for Basic Surgical Knot-Tying Skills

Huang, Emily; Vaughn, Carolyn J.; Chern, Hueylan; O’Sullivan, Patricia; Kim, Edward

doi:10.1016/j.jsurg.2015.01.002

Cited by 22 publications

(15 citation statements)

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“…higher on the knot-tying proficiency checklist have been shown to have more experience, improved performance and increased readiness for the operating room based on experts' opinions. 10 The ability to tie knots at depth has also been correlated with a student's global knot-tying performance, which includes tying on a flat surface and tying atraumatic knots. 10 The ability of novice medical students to achieve significantly higher proficiency with the RHAP knot than with the square knot implies the potential utility of the former as a more reproducible knot in deep body cavities.…”

Section: Discussionmentioning

confidence: 99%

“…10 The ability to tie knots at depth has also been correlated with a student's global knot-tying performance, which includes tying on a flat surface and tying atraumatic knots. 10 The ability of novice medical students to achieve significantly higher proficiency with the RHAP knot than with the square knot implies the potential utility of the former as a more reproducible knot in deep body cavities. Selecting a knot that can be repeatedly and correctly constructed in a deep body cavity has the potential to improve the clinical outcomes of patients, as failure of knots can directly contribute to severe, life-threatening postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

“…Sample size calculation was based on the smallest effect size reported for our primary outcome measure, the knottying checklist score for constructing knots at depth. 10 We calculated a sample size of 10 participants per group, assuming an effect size of 1, a 2-tailed 5% type I error and 80% power.…”

Section: Sample Sizementioning

confidence: 99%

“…It was assessed with a previously validated 5-item surgical knot skills checklist for knot tying at depth (maximum score 10, minimum score 0). 10 Assessment focused on the video recording of the third knot -deemed to be most proficient knot in the series -for each study participant. 10,13 Each assessment was conducted by 3 blinded independent reviewers (V.W., C.Y.…”

Section: Assessmentmentioning

confidence: 99%

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Comparison of knot-tying proficiency and knot characteristics for square and reversing half hitch alternating-post surgical knots in a simulated deep body cavity among novice medical students

Yeung

Sykes³

et al. 2018

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Background: Proficiency-based knot-tying curricula have been developed for square knots for medical students, but, to our knowledge, no such curriculum exists for the reverse half hitch alternating-post (RHAP) knot. We aimed to compare medical students' knot-tying proficiency, knot-tying self-confidence and final knot characteristics for RHAP and square knots in a simulated deep body cavity. Methods: We performed a within-subject prospective crossover study of novice medical students who received 30 minutes of training in tying both RHAP and square knots. Participant performance was assessed via a knot-tying checklist, and knot configuration, tensile strength, tightness (loop circumference) and mechanism of failure were also assessed. Participants' self-reported confidence in knot tying was captured. Results: Twenty-one students participated in the study. Mean scores on the knottying checklist were significantly higher for RHAP knots than for square knots (6.9 [standard deviation (SD) 2.1] v. 5.2 [SD 2.3], p < 0.01), and RHAP knots were significantly tighter than square knots (46.8 mm [SD 0.4 mm] v. 49.3 mm [SD 0.7 mm], p < 0.05). There were no differences between RHAP and square knots in correct knot configuration, breaking strength or mechanism of failure. Reverse half hitch alternating-post knots were easier to tie within a deep-body cavity, whereas square knots were easier to learn. Conclusion: Novice medical students were more proficient in tying RHAP knots than square knots in a simulated deep body cavity. Students were able to construct RHAP knots more securely and reported increased confidence in tying RHAP knots at depth compared to square knots.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Sample Sizementioning

confidence: 99%

Section: Assessmentmentioning

confidence: 99%

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Comparison of knot-tying proficiency and knot characteristics for square and reversing half hitch alternating-post surgical knots in a simulated deep body cavity among novice medical students

Yeung

Sykes³

et al. 2018

cjs

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“…Roberto González L. 1,2 , Héctor Molina Z. 2 , María García-Huidobro D. 2,3 , Patricio Stevens M. 2,3 , Andrés Jadue T. 1 , Alejandra Riquelme U. 2 , Javier Torres M. 2 , Sebastián Barra M. 4 , Felipe Alarcón O.…”

Section: Implementación De Taller De Monitores De Sutura En Alumnos Dunclassified

Implementación de taller de monitores de sutura en alumnos de pregrado de medicina

et al. 2019

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Introduction: Suture techniques are considered the minimum of a medical examination and are fundamental in the practice of medicine. Currently, the students of the Universidad de Concepción do not have a formal instance to acquire these competences. Aim: To evaluate the validity of a training program for Suture Instructor (SI) students through the results obtained through a standardized assessment method, carried out in undergraduate students of medicine at the University of Concepción. Method: Preexperimental before and after study. A theoretical-practical intervention was carried out for six medical students of different semesters of the career, between the months of May and July 2017. It consisted of three modules: theoretical classes, practice in biological model and module in surgical pavilion supervised by subspecialists. Continuous and interrupted sutures were evaluated in the biological model using the "The Objective Structured Assessment of Technical Skills" (OSATS) scale. Results of the OSATS scale are described and compared before and after the course. Informed consent was applied. SPSS® was used for statistical analysis by Mann-Whitney test for non-parametric variables. It was considered significant p < 0.05. Results: All participants improved score on OSATS scale. The participants progressed significantly their results in the different OSATS scales (5.2 vs 8.8, p < 0.05 and 16.5 vs 27.2, p < 0.05) when comparing pre vs post intervention results respectively. Discussion: Our experience shows that it is possible to create an SI training workshop with excellent results for medical students, through a three phase training program, with theory classes, simulation and "in vivo" practice. It also constitutes the basis of future research that seeks to solve the lack of a formal program of teaching suture techniques to medical students of our university.

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Assessment of Surgeon Performance of Advanced Open Surgical Skills Using a Microskills-Based Novel Curriculum

et al. 2022

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IMPORTANCEThe increase in minimally invasive surgical procedures has eroded exposure of general surgery residents to open operations. High-fidelity simulation, together with deliberate instruction, is needed for advanced open surgical skill (AOSS) development. OBJECTIVE To collect validity evidence for AOSS tools to support a shared model for instruction. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included postresidency surgeons (PRSs) and second-year general surgery residents (R2s) at a single academic medical center who completed simulated tasks taught within the AOSS curriculum between June 1 and October 31, 2021.EXPOSURES The AOSS curriculum includes 6 fine-suture and needle handling tasks, including deep suture tying (with and without needles) and continuous suturing using the pitch-and-catch and push-push-pull techniques (both superficial and deep). Teaching and assessment are based on specific microskills using a 3-dimensional printed iliac fossa model. MAIN OUTCOMES AND MEASURESThe PRS group was timed and scored (5-point Likert scale) on 10 repetitions of each task. Six months after receiving instruction on the AOSS tasks, the R2 group was similarly timed and scored. RESULTSThe PRS group included 14 surgeons (11 male [79%]; 8 [57%] attending surgeons) who completed the simulation; the R2 group, 9 surgeons (5 female [55%]) who completed the simulation. Score and time variability were greater for the R2s compared with the PRSs for all tasks. The R2s scored lower and took longer on (1) deep pitch-and-catch suturing (69% of maximum points for a mean [SD] of 142.0 [31.7] seconds vs 77% for a mean [SD] of 95.9 [29.4] seconds) and deep pushpush-pull suturing (63% of maximum points for a mean [SD] of 284.0 [72.9] seconds vs 85% for a mean [SD] of 141.4 [29.1] seconds) relative to the corresponding superficial tasks; (2) suture tying with a needle vs suture tying without a needle (74% of maximum points for a mean [SD] of 64.6 [19.8] seconds vs 90% for a mean [SD] of 54.4 [15.6] seconds); and (3) the deep push-push-pull vs pitch-and-catch techniques (63% of maximum points for a mean [SD] of 284.0 [72.9] seconds vs 69% of maximum points for a mean [SD] of 142.0 [31.7] seconds). For the PRS group, time wasnegatively associated with score for the 3 hardest tasks: superficial push-push-pull (ρ = 0.60; P = .02), deep pitch-and-catch (ρ = 0.73; P = .003), and deep push-push-pull (ρ = 0.81; P < .001). For the R2 group, time was negatively associated with score for the 2 easiest tasks: suture tying without a needle (ρ = 0.78; P = .01) and superficial pitch-and-catch (ρ = 0.79; P = .01). CONCLUSIONS AND RELEVANCEThe findings of this cohort study offer validity evidence for a novel AOSS curriculum; reveal differential difficulty of tasks that can be attributed to specific (continued) Key Points Question How do junior residents and postresidency surgeons perform on specific microskills of a novel advanced open surgical skills (AOSS) curriculum, and how might these findings guide AOSS instruction? Findings...

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An Objective Assessment Tool for Basic Surgical Knot-Tying Skills

Cited by 22 publications

References 11 publications

Comparison of knot-tying proficiency and knot characteristics for square and reversing half hitch alternating-post surgical knots in a simulated deep body cavity among novice medical students

Comparison of knot-tying proficiency and knot characteristics for square and reversing half hitch alternating-post surgical knots in a simulated deep body cavity among novice medical students

Implementación de taller de monitores de sutura en alumnos de pregrado de medicina

Assessment of Surgeon Performance of Advanced Open Surgical Skills Using a Microskills-Based Novel Curriculum

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