Tissue adhesive skills study: the physician learning curve.
OBJECTIVE
To compare 2 educational approaches (structured group session vs. individual instruction) of learning application techniques of 2-octylcyanoacrylate (OCA) on wounds repaired in the emergency department.


METHODS
This prospective, nonrandomized, observational study was conducted in an urban hospital emergency department. Medical students, residents, and faculty were trained in the use of OCA either in a standardized group session or individually, based on their availability to attend the group session. Physicians completed a data collection form that included wound characteristics, type of instruction, and number of lacerations previously repaired with OCA. Impressions of time required, difficulty, and postrepair cosmesis were each recorded on a 5-point Likert scale. The 3 scales were totaled to yield a 15-point summary outcome measure. Univariate nonparametric comparisons of measures were performed between physicians with and without group instruction and between those with and without prior OCA experience. Using 35 subjects in each group, this study had a power of 0.95 to detect a difference of 1.5 points in the 15-point summary score, using alpha = 0.05.


RESULTS
Eighty-one subjects were enrolled; the median summary score was 13 (IQR 12 to 15). There was no statistically significant difference in the summary score, nor any of its 3 components (time saved, difficulty, cosmesis), when comparing physicians with and without group instruction, nor when comparing first-time users to those with prior experience.


CONCLUSIONS
OCA application is an easily acquired skill. Physicians were satisfied with their proficiency in OCA application, regardless of type of instruction received or number of previous lacerations repaired with OCA.
Lin
Michelle
M
Department of Medicine, University of California San Francisco, San Francisco General Hospital Emergency Services, USA. coates@emedharbor.edu
Coates
Wendy C
WC
Lewis
Roger J
RJ
D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D001296:Audiovisual Aids; D002648:Child; D002983:Clinical Competence; D003487:Cyanoacrylates / Q000008:administration & dosage / Q000627:therapeutic use*; D004502:Education, Medical, Continuing / Q000706:statistics & numerical data*; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004954:Esthetics; D005180:Faculty, Medical; D006801:Humans; D007396:Internship and Residency; D022125:Lacerations / Q000628:therapy*; D007858:Learning; D015141:Los Angeles; D010820:Physicians / Q000523:psychology*; D011446:Prospective Studies; D013337:Students, Medical / Q000523:psychology*; D014014:Tissue Adhesives / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D003487:Cyanoacrylates; D014014:Tissue Adhesives; C100832:octyl 2-cyanoacrylate