title: Overcoming the learning curve: a curriculum-based model for teaching zone II flexor tendon repairs.
abstract: BACKGROUND
  Repairs of zone II flexor tendons have benefited in recent years from modifications involving suture technique and configuration. These advances, however, present new obstacles in resident training. A focused tutorial incorporating a practical, hands-on exercise and standardization of technique may offer an effective low-risk, low-cost strategy for overcoming these challenges.
  
  
  METHODS
  Plastic surgery residents (n=14) were asked to perform their preferred zone II flexor tendon repair using a tabletop exercise before and after a focused tutorial. The tutorial reviewed primary literature and presented a standardized technique. Repairs were photographed, tested for load strength, and analyzed to determine effectiveness of this teaching approach. Participants were retested at 6 months to evaluate for persistence of findings.
  
  
  RESULTS
  Posttutorial repairs required higher loads to generate a 2-mm gap (p<0.001) and ultimate breakage (p<0.001). Tendon purchase and resident confidence increased significantly. Subgroup analysis demonstrated significant improvements for both junior and senior residents. Retesting at 6 months revealed that gains were maintained over time.
  
  
  CONCLUSIONS
  The authors created a practical educational model to teach zone II flexor tendon repair outside of the time- and error-sensitive confines of the operating room. Analysis of resident pretutorial repairs revealed common misconceptions in suture technique, strand count, and purchase. This may in part be attributable to the multitude of suggested repair techniques, difficulty in comparing data across multiple studies, and steep learning curve. Training programs can use this hands-on teaching exercise as part of a hand surgery simulation curriculum.
authors.affiliation: Palo Alto, Calif. From the Robert A. Chase Hand and Upper Limb Center, the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, and the Division of Plastic Surgery, Veterans Affairs Palo Alto Health Care System.
authors.forename: Ali Sina
authors.initials: AS
authors.lastname: Bari
authors.forename: Colin Y
authors.initials: CY
authors.lastname: Woon
authors.forename: Brian
authors.initials: B
authors.lastname: Pridgen
authors.forename: James
authors.initials: J
authors.lastname: Chang
mesh_terms: D001696:Biomechanical Phenomena; D002983:Clinical Competence; D003479:Curriculum; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D066298:In Vitro Techniques; D007396:Internship and Residency; D059032:Learning Curve; D017145:Models, Educational; D013518:Surgery, Plastic / Q000193:education*; D013536:Suture Techniques / Q000193:education*; D013708:Tendon Injuries / Q000601:surgery*; D013710:Tendons / Q000502:physiology / Q000601:surgery; D016474:Weight-Bearing