title: Influence of training on reliability of surgical knots.
abstract: OBJECTIVE
  To determine whether trainees in obstetrics and gynaecology tie adequate surgical knots and to assess whether formal training improves knot tying skills.
  
  
  METHODS
  A comparative study assessing surgical knots before and after tuition.
  
  
  METHODS
  Fourteen trainees in a single obstetrics and gynaecology department.
  
  
  METHODS
  A basic surgical skills workshop based in a London teaching hospital.
  
  
  METHODS
  Trainees tied surgical knots around a 120mm jig using 2/0 glycan polymer. Each trainee tied 11 knots before and after a two and a half hour teaching session. Knots were tested using a mechanical testing machine.
  
  
  METHODS
  Knot strength (N); proportion of knots that were 'secure' (defined as those that eventually failed on the testing device by breakage rather than slippage); proportion of knots that were 'dangerous' (defined as those with a tensile strength of < 5 N).
  
  
  RESULTS
  After tuition, the median knot strength of the whole group was 5.7 N stronger than before instruction (95% CI 4.6-12.3 N). Prior to tuition 13.5% (20/148) knots tied had a tensile strength of < 5 N. This was compared with 3.4% (5/148) after tuition (OR = 0.2, 95% CI 0.1-0.6). Before instruction 55.4% (82/148) of the knots were secure compared with 66.9% (99/148) after tuition (OR = 1.6, 95% CI 1.0-2.7).
  
  
  CONCLUSIONS
  Knot tying workshops can improve the ability of trainees in obstetrics and gynaecology to tie reef knots.
authors.affiliation: The Gynaecological Cancer Centre, St Bartholomew's Hospital, London, UK.
authors.forename: T E
authors.initials: TE
authors.lastname: Ind
authors.forename: J C
authors.initials: JC
authors.lastname: Shelton
authors.forename: J H
authors.initials: JH
authors.lastname: Shepherd
mesh_terms: D002983:Clinical Competence / Q000592:standards; D004503:Education, Medical, Graduate; D013502:General Surgery / Q000193:education*; D006176:Gynecology / Q000193:education; D006801:Humans; D009774:Obstetrics / Q000193:education; D013536:Suture Techniques / Q000592:standards*