A better way to teach knot tying: a randomized controlled trial comparing the kinesthetic and traditional methods

Am J Surg. 2014 Oct;208(4):690-4. doi: 10.1016/j.amjsurg.2014.05.028. Epub 2014 Aug 10.


Background: Knot tying is a fundamental and crucial surgical skill. We developed a kinesthetic pedagogical approach that increases precision and economy of motion by explicitly teaching suture-handling maneuvers and studied its effects on novice performance.

Methods: Seventy-four first-year medical students were randomized to learn knot tying via either the traditional or the novel "kinesthetic" method. After 1 week of independent practice, students were videotaped performing 4 tying tasks. Three raters scored deidentified videos using a validated visual analog scale. The groups were compared using analysis of covariance with practice knots as a covariate and visual analog scale score (range, 0 to 100) as the dependent variable. Partial eta-square was calculated to indicate effect size.

Results: Overall rater reliability was .92. The kinesthetic group scored significantly higher than the traditional group for individual tasks and overall, controlling for practice (all P < .004). The kinesthetic overall mean was 64.15 (standard deviation = 16.72) vs traditional 46.31 (standard deviation = 16.20; P < .001; effect size = .28).

Conclusions: For novices, emphasizing kinesthetic suture handling substantively improved performance on knot tying. We believe this effect can be extrapolated to more complex surgical skills.

Keywords: Basic skills; Kinesthetic; Knot tying; Skill; Surgical education; Technical.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Clinical Competence*
  • Education, Medical / methods*
  • Humans
  • Medicine / standards*
  • Reproducibility of Results
  • San Francisco
  • Schools, Medical*
  • Students, Medical*
  • Suture Techniques / education*
  • Sutures / standards*