Knowing Operative Tying: The KnOT Study

Abstract

BACKGROUND: The purpose of this study was to determine if viewing an expert knot tying training video, in addition to the standard medical student curriculum, will result in more proficient surgical knot tying. METHODS: At the start of the clerkship, 20 students were videotaped tying surgical knots for 2 minutes using a board model. Two blinded gynecologic surgeons evaluated proficiency with a standard checklist (score range 0–16) and anchored scoring scale (range 0–20); higher numbers represent better skill. Students were randomized to either (1) expert video or (2) no video. The “video” group was given unlimited access to a knot tying instructional video. At the completion of the clerkship, students were again videotaped and evaluated. RESULTS: At initial evaluation, overall the group mean checklist score was 8.7±4.9, and the anchored scale score was 9.9±4.6 (range 0–18). These pre-clerkship scores did not differ between groups (P=.11 and 0.12, respectively). Post-clerkship checklist scores significantly improved in both the non-video group (14.2±1.6, P=.02) and video group (13.5±2.9, P=.003); similarly, anchor scores also improved in both groups (17.1±3.0, P=.004 and 16.5±3.4, P=.003, respectively). Knot board practice frequency was not different between groups (P=.23). In the expert video group, increased practice significantly correlated with higher post-rotation scores on both the checklist (r=0.69, P<.05) and anchored scales (r=0.68, P<.05). DISCUSSION: The addition of an instructional video appears to have a positive impact on medical student knot tying proficiency.