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Video Tutorial for Teaching Medical Students Hand Surgery Technical Skills: Perception Does Not Equal Reality
Christina Kane, MD; Scott Pascal, MD; Artem Kutikov, PhD; Marci Jones, MD
University of Massachusetts, Worcester, MA

Introduction: Surgical proficiency depends on a high degree of technical skill. To gain these skills, medical students have been traditionally taught with the apprenticeship model. Increased concerns for patient safety, combined with work hour restrictions, have led to new approaches to teach and assess surgical skills. While various methods for garnering surgical skills are available, evaluation of the effectiveness of surgical skills training is limited. We sought to determine the effectiveness of a video tutorial in the acquisition of surgical skills utilizing a flexor tendon repair model; which is both objectively testable and economically favorable.
Methods: Medical students (n=12) interested in pursuing a surgical specialty were recruited in this IRB approved study. Subjects independently viewed a video tutorial reviewing zone II flexor tendon injury and repair. Using surgical simulation with a cadaveric flexor tendon, they then performed a flexor tendon repair with the technique just practiced. Subjects filled out a post-tutorial questionnaire reviewing the quality and usefulness of the content in the video tutorial. Post-tutorial repairs were tested for 2-mm gap and ultimate breaking strength on an MTS machine (MTS Systems Corp., Eden Prairie, MN).
Results: Post-tutorial flexor tendon repairs on average required 19.7 9.1 N of force to create a 2-mm gap. The mean force required for repair failure by suture pullout or rupture was 23.0 10.9 N. 16.7% of post-tutorial repairs were clinically significant with a load to failure 35 N (Figure 1). 75% students thought the video tutorial was an effective method of learning zone II flexor tendon repair technique and 90% stated surgical simulation videos would be a valuable asset to their future education in surgical residency.
Conclusions: Although 75% of medical students thought the video tutorial was an effective teaching tool for learning zone II flexor tendon repair technique, only 16.7% produced clinically significant repairs. Video tutorials may be insufficient to teach medical students advanced surgical skills, especially for technically challenging procedures. This model may be better suited for use in resident education. Despite the misperception of the medical students ability to perform a clinically significant repair, the majority felt surgical simulation videos would be a valuable asset to their future surgical residency curriculum. With limited time during residency, effective and reliable teaching tools for technical skills, which are level appropriate, must be available.

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