Remote video-based suturing education with smartphones (REVISE): a randomized controlled trial

ABSTRACT

Background: Suturing is a skill that surgical trainees must master. Owing to the COVID-19 pandemic, medical schools needed to transition from in-person to virtual avenues of teaching, including procedural skills. Our primary objective was to determine whether virtual video-based feedback is no worse than in-person feedback in improving novice medical students' suturing skills. Methods: Fifty-four medical students were randomly assigned either to an experimental arm in which they received remote-recorded feedback (RRF) or remote-live feedback (RLF) or to a control arm in which they received in-person feedback (control). There were 18 participants in each group. Participants first learned to suture via an online module then recorded themselves performing a standardized suturing task at home. Customized feedback was then provided by a surgical resident who received standardized training for this project. Results: RRF participants received a feedback video, RLF participants received live feedback over Zoom and control participants received feedback in person. Participants then recorded another video of the same suturing task. Prefeedback and postfeedback suturing performances were scored by blinded assessors using the University of Bergen Suturing Skills Assessment Tool (UBAT). Our primary outcome measure is the score difference between pre- and post-feedback videos. The RLF and RRF groups were compared for statistical significant differences using a 2-tailed paired t test. Results: Twenty-seven participants (median age 22) were included in the interim analyses. Postfeedback UBAT scores were not significantly different between groups (70.34 [interquartile range (IQR) -25.41 to 127.34] v. 11.34 [IQR -99.66 to 78.34], p > 0.05), with a higher score indicating better performance. Although there was a trend toward RLF demonstrating greater improvement (32 [IQR -10 to 59.25] v. 25 [IQR -63 to 77], p > 0.05), this was not statistically significant. Conclusion: Thus far, there has been no significant difference between groups in prefeedback scores, postfeedback scores or score difference. Future steps include analyzing videos for all participants and comparison with the control arm.