Cross-Suturing is Effective for Teaching Suturing Skills: A Randomized, Controlled Trial

• Published in: The Journal of surgical research Vol. 281; pp. 228 - 237
• Main Authors: Cemaj, Sophie L., Connely, Thomas W., Hon, Heidi H., Tieken, Kelsey R., Figy, Sean C., Wong, Shannon L., Fingeret, Abbey L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2023
• Subjects: Clinical Competence; Cross-stitching; Education; Humans; Self-Assessment; Students, Medical; Suture Techniques - education; Sutures; Suturing; Suturing; Cross-stitching; Art; Education
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2022.08.038

Basic suturing is a skill expected from graduating medical students. A proposed concept to increase suturing competency is to integrate art by mixing cross-stitching with suturing. We hypothesize that students trained with “cross-suturing” would improve suturing performance. We performed a randomized controlled trial of preclinical medical students using an art-based cross-stitching method intervention compared with conventional suturing. Both groups were provided with an introductory suturing video. Assessment of simple interrupted suturing were conducted preintervention and postintervention, and at 2-wk follow-up with a video review by blinded expert raters using the American College of Surgeons basic suturing and knot tying performance rating tool. Students completed a self-assessment of proficiency, confidence, and anxiety. Statistical analysis was performed using unpaired t-tests. A total of 16 preclinical medical students participated. Self-assessment and objective suturing performance were comparable in the preintervention measurements. The intervention group showed significant improvement compared to the control group with median (interquartile range) self-assessment scores 9 (8.5-9) compared with 6.5 (6-7.5) (P < 0.01) and objective performance scores of 25.25 (22.75-27) compared with 16.5 (14.5-18.5) (P < 0.01). The intervention group showed retained skills at the 2-wk follow up with no differences in self-assessment or objective suturing scores immediately postintervention compared with two-wk follow-up with self-assessment scores of 9 (8.5-9) versus 9 (8-9) at 2 wk (P = 0.16) and objective performance score of 25.25 (22.75-27) versus 24.75 (23.5-26.5) at 2 wk (P = 0.29). The cross-suturing intervention improved suturing skills in this cohort. This low-cost approach to medical student surgical education should be explored on a larger scale.