Telementoring of Open and Laparoscopic Knot Tying and Suturing Is Possible: A Randomized Controlled Study

 

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Abstract

Aim Several motor learning models have been used to teach highly complex procedural skills in medical education. The aim of this randomized controlled trial was to assess the efficiency of telementoring of open and laparoscopic suturing of medical students compared to conventional in-person teaching and training.

Methods After randomization, 23 medical students were assigned to either the telementoring or the in-person training group. Both groups were taught by surgically trained residence with a student–teacher ratio of 1:1 (teacher–student). Open suturing was assessed in a model of congenital diaphragmatic hernia and laparoscopic suturing in a model of bowel anastomosis. All subjects were trained according to the spaced learning concept for 3 hours. Primary end points were time, knot quality, precision, knot strength, and overall knotting performance/competency. Furthermore, we utilized the Surgery Task Load Index to evaluate the cognitive load of both teaching techniques. Students' subjective progress regarding skill acquisitions and acceptance of telementoring was assessed using a nine-item questionnaire.

Results All 23 trainees significantly improved after training in all knot attributes. More than 90% of all subjects reached proficiency in both groups. In-person training and telementoring were similarly practical, and no significant differences regarding speed, knot quality, precision, knot stability, and procedure performance/competency were found. Students perceived no difference in acquisition of factual or applicational knowledge between the two groups. General acceptance of telementoring was moderate in both groups before training, but increased during training in students actually assigned to this group, in comparison to students assigned to conventional teaching.

Conclusion The current study shows that telementoring of open and laparoscopic suturing is an ideal answer to the current coronavirus disease 2019 pandemic, ensuring continuous training. On-site training and telementoring are similarly effective, leading to substantial improvement in proficiency in intracorporeal suturing and knot tying. Likewise, students' subjective progress regarding skill acquisitions and cognitive load does not differ between teaching methods. Skepticism toward telementoring decreases after exposure to this learning method. Given our results, telementoring should be considered a highly effective and resource-saving educational approach even after the current pandemic.

Ethics Approval

The medical ethics committee of the Medical Association of Hamburg (Ethik-Kommission der Ärztekammer Hamburg) declared that no formal ethical approval was needed for this study.

Authors' Contribution

J.E. acquired the data, acted as course instructor, conceptualized the questionnaire, validated statistics, drafted the initial manuscript, and approved the final manuscript as submitted. J.B. acquired the data, conceptualized the questionnaire, performed statistics, drafted the initial manuscript, and approved the final manuscript as submitted. D.V. acquired the data, acted as course instructor, and approved the final manuscript as submitted. D.S. acquired the data, acted as course instructor, and approved the final manuscript as submitted. T.T. acquired the data, acted as course instructor, and approved the final manuscript as submitted. K.R. conceptualized and designed the study and approved the final manuscript as submitted. M.B. conceptualized and designed the study, acquired the data, acted as course instructor, performed statistics, drafted the initial manuscript, and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Publication History

Received: 03 September 2021

Accepted: 23 November 2021

Article published online:
13 January 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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