A Cost-Effective Proficiency-Based Knot-Tying and Suturing Curriculum for Residency Programs

Background

The purpose of this study was to develop a structured open skills curriculum for knot-tying and suturing using expert-derived performance goals and to examine its feasibility, cost-effectiveness, and construct validity.

Methods

Using commercially available bench models, 11 standardized tasks (ranging from 2-handed knot-tying to running subcuticular closure) were developed and scored using previously validated metrics based on time and errors. Expert performance was used to establish training endpoints and to create a video tutorial. PGY 1 residents (n = 4) were enrolled in a prospective Institutional Review Board-approved pilot study that included proctored orientation and baseline testing, self-training to proficiency, and proctored post-testing (conducted over a 4-wk period). Baseline trainee scores were compared with expert scores to evaluate construct validity.

Results

The 11 tasks proved relatively robust, and excellent feedback was obtained from the trainees regarding educational benefit. Overall, trainees performed 144 ± 33 repetitions over 11 ± 2 h. Trainees achieved proficiency for 4.6% of the 11 tasks at baseline, 91% during training, and 84% at post-testing. Trainees demonstrated significant improvement from baseline to post-testing, validating skill acquisition; baseline trainee and expert performance were significantly different, confirming construct validity. Curriculum development cost $1200 and required 72 man-hours. Incremental training cost less than $12 per participant and required 8 man-hours per rotation using the video-based self-practice curriculum. In response to participant feedback, two of the 11 tasks were modified and a twelfth task was added.

Conclusions

This curriculum is cost-effective, feasible within the context of residency training, educationally beneficial, and demonstrates construct validity. More widespread adoption of standardized, validated skills curricula such as this by residency programs is warranted.

Key Words: surgical education, skill acquisition, knot-tying and suturing curriculum, skills training, skills lab, technical skills, suturing models, simulation