Original ReportsTutoring Trainees to Suture: An Alternative Method for Learning How to Suture and a Way to Compensate for a Lack of Suturing Cases
Introduction
Suturing is one of the most challenging basic procedures in medical training and is a basic requirement for general practitioners. Methods of teaching suturing at most medical schools include lecture, video, and one-to-one demonstration, either on simulator or on real patients. Bath and Lawrence1 proposed an approach for teaching procedural skills that had the tutor start by demonstrating the procedure. The tutor then repeats the procedure, explaining the process. The student then instructs the tutor by repeating the procedure and similarly describing the steps of the process. The tutor then concludes the teaching session by providing student feedback.1 Although this teaching methodology is simple and easy to describe, it is difficult to implement effectively and it leaves many students feeling inadequately prepared to perform suturing.2, 3 To solve this problem and increase the level of suturing competency, other training methods must be identified to enhance the learning process and accelerate the learning curve.4
“See one, do one, teach one” was at one time the popular method of teaching and learning surgery, but has, over time, fallen out of favor.5, 6 This learning method combines explanation, action, and demonstration. Given the number “one” in the “see one, do one, teach one” method, learners acquire inadequate levels of experience with patients and often do not feel sufficiently trained to carry out procedures safely by themselves.5 As the process of teaching and learning surgery continued to evolve, the concept of a “learning curve” became more popular.7, 8 In a “learning curve” learning environment, students perform and practice a procedure until achieving a level of skill that allows them to confidently and competently perform a procedure on their own. This added experience by doing and doing again contributes to incremental outcome improvement and, eventually, plateaus in an ability to perform independently.7
A major difference between the “see one, do one, teach one” and learning curve styles is that “see one, do one, teach one” involves teaching (tutoring) as a process component of learning. It has been reported that learning to teach is significantly better than learning to be tested, because those who learn to teach tend to have more intrinsic motivation.9 This teaching and tutoring component may augment the learning curve.
In today’s medical learning environment, medical students have fewer opportunities to perform suturing, because of higher student-patient ratios and legal issues. Tutoring in suturing training was developed to compensate for this obstacle to suturing skill development. This study aimed to compare ideal suturing score (ISS; 9 points), suturing time (min:sec), and suture placement error (mm) between the group completing the tutoring program (study group) and the group that received suturing training in the ordinary medical school program (control group).
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Study Design
This was an experimental study. The study group consisted of medical students who were given the additional role of suturing tutor without any practice on real patients. The inclusion criteria were as follows: 1st-3rd year medical students (6-year curriculum), no prior surgical training, ability to participate in all phases of training and attend all teaching sessions, and voluntary participation. It was emphasized that participation in this study was voluntary, that it would not affect their
Results
There were 41 participants in the study group and 40 participants in the control group. The flow diagram for this study and a summary of results for both the groups are presented in Figure and Table, respectively. In the study group, ISS showed slight and gradual improvement. When comparing week 1-week 10, significant improvement was seen in ISS scores (7.0 ± 1.3 vs. 8.2 ± 0.9, p = 0.01) and suturing time was decreased (6:5 ± 1.5 vs. 5:1 ± 1:0, p = 0.02). Mean placement error score was also
Discussion
In this study, tutoring trainees to suture aimed to enhance suturing skills and to compensate for a lack of suturing practice on real patients in the regular curriculum. In the study group, this learning method was shown to significantly improve suturing skills after 10 weeks of learning. It also improved suturing time and placement error rates. Suturing skills develop with repeated practice and years of experience; after which suturing becomes an unconsciously competent or mastered skill.
Conclusion
Tutoring in suturing training is an alternative learning method for medical students, which demonstrated improvement in suturing scores by times. The final learning outcome was at least comparable to the outcome of learning suturing via regular medical school curriculum. However, tutoring in suturing training may not be able to adequately replace real patient suturing experience.
Acknowledgments
The authors gratefully acknowledge Dr. Jetbodin Prakoonsuksapan, Dr. Pakkathorn Sivapiromrat, and Dr. Thitiporn Chaiwongrungreung for their help in conducting this research.
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The authors report no conflict of interest. The authors alone are responsible for the content and writing of this article.