External validation and evaluation of an intermediate proficiency-based knot-tying and suturing curriculum

J Surg Educ. 2014 Nov-Dec;71(6):839-45. doi: 10.1016/j.jsurg.2014.04.013. Epub 2014 Jun 10.


Purpose: The purpose of this study was to perform external validation, examine educational effectiveness, and confirm construct validity of a previously developed "intermediate-level, proficiency-based knot-tying and suturing curriculum" in preparing residents to achieve proficiency in more advanced open surgical techniques.

Methods: A total of 47 postgraduate year-1 (PGY-1) surgery residents completed 6 intermediate-level knot-tying and suturing exercises. Baseline trainee performance was compared with intermediate and senior (PGY-3 and PGY-4) residents (n = 12) and expert faculty (n = 4).

Results: PGY-1 overall proficiency increased from 21.1% at baseline to 92.1% during posttest for all 6 exercises combined (p < 0.001). When compared with the PGY-3 and PGY-4 residents, at baseline intermediate and senior residents scored higher on half of the exercises. However, during posttesting PGY-1 residents not only matched, but also surpassed PGY-3 and PGY-4 residents' performance in 3 of 6 exercises. Significant differences on all 6 exercises were also found during pretesting when comparing interns against faculty, demonstrating construct validity. However, upon completion of the curriculum, PGY-1 residents' posttest scores were equivalent, if not significantly better than expert faculty performance.

Conclusion: We obtained similar results as those previously reported, showing external validation. Additionally, we demonstrated that first-year surgical residents could achieve performance levels that match or exceed those of senior residents and experienced surgeons on these exercises with 4 weeks of training.

Keywords: Patient Care; Practice-Based Learning and Improvement; Systems-Based Practice; curriculum development and implementation; open knot-tying and suturing skills; proficiency-based skills training; simulation-based surgical training.

Publication types

  • Validation Study

MeSH terms

  • Clinical Competence*
  • Curriculum
  • Education, Medical, Graduate*
  • Educational Measurement*
  • Humans
  • Internship and Residency*
  • Suture Techniques / education*