Early and prolonged opportunities to practice suturing increases medical student comfort with suturing during clerkships: Suturing during cadaver dissection

Abstract

Medical students are expected to perform common procedures such as suturing on patients during their third-year clerkships. However, these experiences are often viewed by medical students as stressors rather than opportunities for learning. The source of this stress is the lack of instruction on common procedures prior to being asked to observe or perform the procedure on a patient. First-time exposures to procedures in stressful environments may result in decreased confidence in medical students and decrease the frequency with which they perform these procedures in the future. The authors sought to change this paradigm by: (1) introducing a suturing module to first-year medical students in the context of the anatomy dissection laboratory and (2) measuring its effects on student attitudes and behavior over the course of their third-year clerkships when they encounter patients. The authors found that early and prolonged introduction to suturing was associated with increased student confidence relative to suturing a patient. Participation in the suturing module was associated with increased student confidence in identifying suturing instruments (P < 0.001) and suturing patients (P = 0.013). Further it positively affected their behavior as demonstrated by increased performance of suturing events from students exposed to the suturing module. (P < 0.001) This study demonstrates that early and prolonged opportunities to practice a procedural skill in a low-stress environment increases student confidence during patient interactions and alters student behavior.

Keywords: behavioral change; confidence; early exposure; gross anatomy education; gross anatomy laboratory; medical education; surgical skills; suturing module.

Figure 1

Stills from instructional video. A, Instruments - needle driver, scalpel, suture, forceps and scissors; B, Starting at one end of an incision on the lower extremity enter the skin with the needle in a perpendicular manner by rotating your wrist and moving the needle through the skin along a curvilinear trajectory; C-E, Make a surgeon’s knot, or “double throw,” using an instrument tie, pulling gently on both sides of the suture and cutting the excess suture material; F, Three evenly spaced sutures completely close the incision.

Figure 2

Schematic of research design. The Anatomy Laboratory Suturing Module (ALSM) was introduced to the Class of 2017 (Intervention group) in the anatomy dissection laboratory, during the first year of medical school. Pre- and Post-ALSM surveys were conducted for the Class of 2017. Pre- and post-clerkship surveys for the Class of 2017 and Class of 2016 (Control group) were conducted at the beginning and on completion of the third-year clerkships.