Open knot-tying skills: residents skills assessed

Aim: Open knot-tying and suturing skills are fundamental surgical skills, founding many alternative knot-tying techniques. It is therefore mandatory for residents to possess adequate basic open knot-tying skills. The aim of this study was to compare an objective assessment of open knot-tying skills by residents to a resident's own estimation of his or her knot-tying skills, before and after a knot-tying course.
Material and Methods: A prospective observational cohort study was performed. At baseline level, after 1 training day in the Advanced Suturing Course (ASC) in the Netherlands and Belgium and after 6 weeks of autonomous practice (i.e. self-practice), 99 residents' open knot-tying skills were objectively evaluated using the Objective Structured Assessment of Technical Skills (OSATS). The resident's own confidence in these skills was also evaluated.
Results: The ASC substantially and significantly improved residents' knot-tying skills according to the OSATS between baseline and post-measurement. The observed improvement after 1 training day decreased after 6 weeks of autonomous practice. Self-confidence increased directly after the training program and was maintained 6 weeks later. Residents having completed the first 3 years of residency displayed an overall greater self-confidence than residents not having completed the first 3 years of residency, although the increase in self-confidence was significantly larger in the latter after 6 weeks' autonomous training.
Conclusion: There is a divergence between residents' objectified open knot-tying skills and self-confidence in these skills. The ASC improved open knot-tying skills according to the OSATS, however this improvement decreased after a 6-week period of autonomous practice. Self-confidence, in contrast, was maintained or increased. Further research is needed to correlate validated training programs with clinical outcomes and to determine whether residents' open knot-tying skills and self-confidence are retained beyond 1 year.