gms | German Medical Science

Introduction: Training needs of students in respect to stepwise acquisition of basic surgical skills are rarely explored. Training curricula are generated according to defined learning goals, established by authorities in the field. However, training curricula are not created to prevent typical psychomotoric errors encountered by most of the students.

We raised the hypothesis that identification of typical errors is the prerequisite for the development of error-preventing exercises.

Method: Students performed an interrupted suture with 3 stitches on a foam pad during a facultative OSCE. The procedure was video-taped and analysed according to pre-defined criteria of all procedural steps: handling of instruments and sutures, knotting, and cutting suture lines.

Analysis of the frequency and “mechanism” of the errors were used as basis to design exercises needed for preventing errors.

Results: All 30 students had some errors in their procedure, but of highly varying severity The detailed analysis of video-material revealed 4 main errors: Errors occurred in all steps of procedure:

1.

Geometry of needle in needle holder and of needle holder in hand of trainee was inappropriate leading to non-physiological movement when placing stitch.

2.

Handling of suture line was not adjusted to surgical field leading to extremely wide movements.

3.

Knotting procedure was performed with inadequate length of suture ends leading to difficulties performing the knot.

4.

Instruments were displaced for cutting suture line leading to additional steps to reposition the instruments.

Performing the newly developed instrument handling and knotting exercises prior to performing the whole complex procedure already proved to be helpful as tested in a small pilot study.

Discussion: This observational study represents a new approach in video-based teaching. Videos are not only used to enhance the performance of the students but to improve the training procedure by analysing errors in terms of their “mechanism” and frequency.