Improved Strategies for Teaching Surgical Skills to Medical Students: Simulation and Beyond

Abstract

PURPOSE: Develop a curriculum to optimize surgical skills and to increase operating room (OR) opportunities for medical students. BACKGROUND: Simulation-based strategies for teaching surgical skills are evolving. Using an innovative task trainer, we compared one-on-one deliberate practice to video-based self-guidance in the performance of two-handed knot tying and subcuticular suturing during the OBGYN clerkship. METHODS: A randomized prospective trial compared two groups of third year medical students in the same clerkship rotations. Group A received one-on-one deliberate practice undergoing three sessions with an instructor and Group B received unlimited access to video-based self-guided practice over six weeks. At the end of the clerkship, surgical performance was assessed using the validated checklist. Self-reported data regarding OR experience was collected using a specifically designed phone application. RESULTS: Fifty-nine students participated in the study. Group A demonstrated a statistically significant improvement in two-handed knot tying and subcuticular suturing in pre-post assessments (knot-tying +4.34, P<.001; suturing +19.4, P<.001). Group B demonstrated a statistically significant improvement (knot-tying +6.03, P<.001; suturing +22.3, P<.001). No significant differences were found between groups in overall knot-tying (P=.13), suturing (P=.14), hours practiced (P=.90), or number of OR cases (P=.49). DISCUSSION: The use of simulation significantly improved surgical skills for all students from baseline. No differences were found between one-on-one deliberate practice and video-based self-guided practice. Both instructional strategies provided equal efficacy in teaching surgical skills and optimizing surgical performance for students during the OBGYN clerkship.