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Surgical Skills Training Restructured for the 21st Century

2012; Elsevier BV; Volume: 172; Issue: 2 Linguagem: Inglês

10.1016/j.jss.2011.11.323

1095-8673

Michael W. Morris, Robert C. Caskey, Marc Mitchell, David Sawaya,

History of Medical Practice

Introduction: Few if any medical schools have a comprehensive surgical skills program taking medical students from learning basic knot tying and suturing skills to performing these skills at a level adequate for function during a primary care, surgical or subspecialty residency. We designed and continue to refine a skills program consisting of 5 workshops during the third year surgical rotation. Methods: During the first workshop students learn how to tie both one and two-handed surgical knots. the focus of the second workshop is teaching the differences in suture type and use, instrument handling and suturing techniques such as simple interrupted, running, running locking, subcuticular, and mattress stitches. the third workshop is a supplemental workshop to address problems and refine techniques previously learned. A final examination to evaluate suture and knot tying skills comprises the fourth workshop. to pass this skills exam students must be able to tie one and two-handed surgical knots and perform two of the previously mentioned suturing techniques. the fifth session is a voluntary knot tying and suturing competition evaluating three categories. the first category determined the speed and finesse of knot tying in thirty seconds. Knot-tying points were lost for different tying errors including improper form, dropping the suturing while tying, and throwing air knots. the second category determined suturing tightness, symmetry and aesthetics while closing a simulated laceration with a running suture. the third category determined the water-tightness of a repaired latex tube after a 75% transection. Photographs of all materials were obtained at the completion of the competition. Certificates are presented to the winners of each individual category. A “Top Gun” plaque is presented to the overall winner. Results: All third year students at our medical school participated in this program over the past 18 months, and each student demonstrated competency in basic knot tying and suturing for completion of the skills exam. the results of the knot-tying portion of the competition revealed the fastest student performing 16 throws every thirty seconds. 5% of students had excellent knot-tying technique losing no points for tying errors. Suturing evaluation revealed combined excellence in symmetry, tightness, and aesthetics in 10% of students. Results of the third category of the competition revealed water-tight competency of the vascular surgical repair during pressure testing in 10% of the students. Conclusions: This program produces medical students with a fundamental surgical skill set, appreciation of surgical technique, and the confidence to perform basic surgical skills when required during their internship. Additionally, identifying the most technically proficient students may assist with career counseling residency recruitment.