A Novel Approach to “See One, Do One”: video presentations before suturing workshops
Amita Sudhir MD, Claire Plautz MD, Nick Simpson, William Woods, MD
Department of Emergency Medicine
University of Virginia Health System, Charlottesville, Virginia
Funded by an Academy of Distinguished Educators Undergraduate Medical Education Grant

Hypothesis

We hypothesized that students who receive video preparation before a suturing workshop would perform better on a standardized test of their suturing skills administered immediately after the workshop than students who received a traditional instructional lecture. They may also feel more confident about their skills.

Research Design

88 first and second year medical students were randomized into two equal groups. Students that had prior suturing experience were randomized separately so that there were equal numbers of experienced students in each group. The control group was given a traditional procedure workshop--a didactic lecture followed by 40 minutes of suturing practice time. The video group was provided with the New England Journal of Medicine online suturing video upon group assignment, and given 40 minutes of practice time during the workshop, but no lecture.

Both groups were asked to rate their confidence in their suturing abilities on a 5-point Likert scale, from “(1) strongly disagree” to “(5) strongly agree”, both before and after the workshop. After the workshop, both groups were asked to rate their belief in the workshop’s effectiveness in teaching them the basics of suturing on the same scale. The two groups’ responses to these statements were compared.

Each student was also videotaped suturing a pig’s foot for 5 minutes after the workshop. The videotapes were viewed at a later date and students were graded on a previously validated 16 point suturing checklist. (Only 83 videos were able to be viewed—3 were lost and 2 were of poor quality, leaving 42 in the video group and 41 in the control group. We compared the mean scores between the video group and the control group. We also compared the proportion of students in each group that performed each individual point on the checklist correctly.

Results

Survey Results: Students in the video group were found to be 2.45 times more likely to have a neutral or favorable feeling of suturing confidence before the workshop (p=0.067, CI 0.94-6.4) using a proportional odds model. No association was detected between group assignment and level of suturing confidence after the workshop (p=0.475) using a proportional odds model. There was also no association detected between group assignment and opinion of the suturing workshop (p=0.681) using a logistic regression odds model. Among those students who indicated a lack of confidence before suture training, there was no detected association (p=0.967) between group assignment and having an improved confidence in their suturing skills using a logistic regression odds model.

Test Results: There was no significant difference between the test scores of the lecture group (M=11.21, SD=3.17, N=42) and the video group (M=11.27, SD=2.53, N=41) using the two sample independent t –test for equal variances (t(81)=-0.09, p=0.93).

There was a statistically significant difference in the proportion of students scoring correctly for only one point on the suturing test: “Curvature of needle followed” : 25/42 in the lecture group and 35/41 in the video group.

(chi=6.92, df=1, p=.008)

Conclusions

It appears that after the workshop, both groups were equally confident about their suturing, and had similar feelings about the workshop’s effectiveness. Additionally, both types of workshop appear equally effective in improving the confidence of those students who lacked confidence initially. Results of the suturing test show that students in the video group and students in the control group achieved similar levels of suturing skill. This study suggests that video instruction could be a reasonable substitute for lectures in procedural education. Merely viewing the video had an impact on students’ pre-workshop confidence levels, suggesting that video instruction could be used in addition to a lecture to improve confidence in procedural skills. The use of video in procedural education opens many doors: it allows instructor time to be spent in one-on-one, hands-on instruction, it allows students to direct their own learning, and it helps engage learners from a generation used to receiving small, time efficient “bites” of information.