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November 2004

An Education Theory–Based Method to Teach a Procedural Skill

Arch Dermatol. 2004;140(11):1357-1361. doi:10.1001/archderm.140.11.1357

Objective  To determine the effectiveness of an education theory–based method to teach students to place and tie a simple interrupted stitch.

Design  A teaching intervention before-after trial.

Setting  Dermatology department, academic university.

Participants  Fourth-year medical students and dermatology residents.

Main Outcome Measures  Scores on a 12-criterion grading instrument before and after instruction.

Results  The scores for medical students and residents in each class showed significant improvement. The mean score for all participants (N = 23) rose by 24% after instruction (P< .001). Scores in 9 of the 12 graded performance areas improved significantly after instruction, including scores in tissue damage/teeth marks (P<.001), needle dulled/bent (P< .001), needle loaded properly and knots square (P = .01), throws done correctly (P = .01), stitch tension and needle entry/exit angle (P = .02), amount of suture used (P = .03), and correct number of throws (P = .04). In addition, participants’ confidence increased significantly after instruction (P<.001). No difference was noted between men and women in preinstruction vs postinstruction score improvement.

Conclusions  This teaching method can be effectively used to teach students to place and tie a simple interrupted stitch. Once validated and expanded, it may prove useful in shortening and standardizing procedural skill training and in objectively documenting competency.