Year One Outcomes Assessment of a Masters Suturing and Knot-Tying Program for Surgical Interns

Abstract

We implemented and evaluated the outcomes of a proficiency-based program to enhance basic suturing and knot-tying skills in surgical interns. A suturing and knot-tying "masters program" was implemented for 9 surgical interns. Assessment consisted of timed and videotaped technical performance (TP) of 6 suturing (simple interrupted, subcuticular, and vertical mattress) and tying tasks (1-handed, 2-handed, and tie on pass) preinstruction (baseline) and at 4 months. Feedback and remediation were done after 4 months, and interns were retested until goals were met. TP was scored on a 1-5 scale (1 = novice, 3 = proficient, and 5 = expert). The results were compared with 6 end of PGY2 year residents and rotation evaluations, case numbers, and American Board of Surgery In-Training Examination (ABSITE) scores. The data are mean ± standard deviation (SD); statistical analysis was by 1-way ANOVA, Kruskal-Wallis test, and Pearson correlation. The total combined task times improved significantly from initial (1289 ± 301 seconds) to final assessment (770 ± 139 seconds, p = 0.0003) and between 4-month assessment (1092 ± 253 seconds) and final assessment (p = 0.0237), but not baseline to 4-month assessment (p = 0.213). Final TP scores were improved significantly (baseline, 1.87 ± 0.81; 4-month assessment, 2.63 ± 0.75; and final assessment 3.51 ± 0.39 [p < 0.001]. All interns reached proficiency on 6/6 tasks but not until 10.1 months (range, 4-12 months) and 2.4 assessment sessions (range, 1-3). No significant differences in final total task times or TP scores were found between interns (770 ± 139 seconds and TP, 3.51 ± 0.39) and end of PGY-2 residents (677 ± 109 seconds and TP, 3.6 ± 0.43). The total task time and rotation technical comments were associated significantly, but TP scores, case numbers, and ABSITE scores were not. Training, feedback, and remediation are necessary to reach proficiency in basic suturing and knot tying. This program provides an objective assessment of interns' skills not discernible by conventional measures.