Face-to-Face Versus Distance Learning of Basic Suturing Skills

Study Overview
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Brief Summary
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The main objective of this study is to determine the acceptability and effectiveness of Distance Learning (DL) of basic suturing skills in novice learners. A prospective randomized controlled trial involving 118 pre-medical and medical students with no previous experience in suturing was conducted. Participants were randomized into two groups for learning simple interrupted suturing: F-F and DL groups (59 students in each group) . Evaluation was conducted by two independent assessors. Agreement between the assessors was calculated, and performance scores of the participants were compared between the two groups. All the participants demonstrated their ability to place three interrupted sutures, with no significant difference in the performance between the two groups. All the respondents positively rated the teaching sessions, found them useful and enjoyable. Distance learning of basic suturing is as effective as the face-to-face approach in novice learners

Detailed Description
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At our hospital, during the initial lock-down period in March and April 2020, all medical students' clinical clerkships were temporarily cancelled, and their educational activities switched to web-based remote learning, utilizing teleconferencing and commercially available web-based interactive clinical modules. Teaching surgical technical skills, such as basic suturing, presented itself as a more challenging component of the clinical education under these unusual circumstances as compared to teaching cognitive skills and knowledge, which raised questions and concerns around the effectiveness and acceptability of distance learning of basic surgical skills. In this study, the investigators aimed to compare the effectiveness and retention of distance learning to the traditional face-to-face learning of basic (simple interrupted) suturing in novice learners. This study entails a prospective randomized trial involving two arms (traditional face-to-face versus distance learning of basic simple interrupted suturing) in pre-medical students as well as first and second year medical students at the American University of Beirut (AUB). Immediately after the teaching session as part of research, two independent surgeons assessed the students' simple interrupted suturing performance using a validated checklist and OSATS global rating. The difference in performance was used to determine the effectiveness of distance learning of basic suturing as compared to the traditional instructional method. In addition, the students in both groups were asked to complete a questionnaire (immediately after the teaching session) to investigate their satisfaction and confidence.

Official Title
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Traditional Face-to-Face Versus Distance Learning of Basic Suturing Skills in Novice Learners

Conditions
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Educational Problems

Intervention / Treatment
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* Other: Tele simulation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pre-medical, first, and second-year medical students with no previous experience in suturing. Exclusion Criteria: Previous experience in suturing.Refusal of enrolment.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 25 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Control group: Face-to-Face learning of simple interrupted suturing<br>The students watched a video demonstrating simple interrupted suturing, with the instructor commenting on the steps. The students then watched the video again. The instructor then demonstrated the procedure for the students. The students then practiced suturing with immediate and specific feedback provided by the instructor until he and the students were satisfied with the performance. | |
| Study group: Distance learning (tele simulation) of simple interrupted suturing<br>The instructor ran the interactive tele simulation sessions utilising web-based video-conferencing technology (WebEx platform). The students used their personal smartphones or laptops with audio-video capabilities. The instructor ran the session through his smartphone. The instructor shared a video demonstrating simple interrupted suturing while commenting on the steps (the same video used in the control group). The instructor then ran the video again for the students. The instructor then demonstrated the skill for the students by turning on his camera. The students then practiced suturing, and periodically turned on their cameras to receive live and specific feedback from the instructor on their performance, until the instructor and the students were satisfied. No face-to-face interactions between the students and the instructor. | Other: Tele simulation<br>* Interactive tele simulation sessions utilising web-based video-conferencing technology (WebEx platform).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Assessment of suturing skills in medical students via checklist | The adopted ten-item checklist for assessing suturing skills in medical studentS differentiated between novice and expert performances and showed a narrow variation in the scores provided by three independent expert assessors. Overall performance scores were calculated based on the formula used by the same authors: cutoff time (seconds) - completion time (seconds) - (10 x sum of errors) with higher scores indicating better performance | immediately after the intervention(suturing session) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Assessment of suturing skills in medical students via OSATS | OSATS is a validated observational assessment tool also used in medical students. It comprises of seven performance domains whereby learners are scored on a 5-point Likert scale on proper tissue handling, efficiency and economy of movements, instrument handling, suture handling, flow of the procedure, knowledge of the steps of the procedure, overall appearance of the suture, in addition to an overall assessment of the performance; higher scores indicate better performance | immediately after the intervention(suturing session) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Medical Education, Suturing Skills, Face-to-Face learning, Distance Learning, Pandemic