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

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.