title: Visual force feedback improves knot-tying security.
abstract: BACKGROUND
  Residents in surgical specialties suture multiple wounds in their daily routine and are expected to be able to perform simple sutures without supervision of experienced surgeons. To learn basic suture skills such as needle insertion and knot tying, applying an appropriate magnitude of force in the desired direction is essential. To investigate if training with real-time visual force feedback improves the suture skills of novices, a study was conducted using a training platform that measures all forces exerted on a skin pad, i.e., the ForceTRAP.
  
  
  METHODS
  Two groups of novices were trained on this training platform during a suture task. One group (nov-c) received no visual force feedback during training, whereas the test group (nov-t) trained with visual feedback. The posttest and follow-up test were performed without visual force feedback.
  
  
  RESULTS
  A significant difference in reaction force, (nov-c: mean 2.47N standard deviation [SD] ± 0.62, nov-t: mean 1.79N SD ± 0.37), suture strength (nov-c: median 25N interquartile range (IQR) 15, nov-t: median 50N interquartile range 25), and task time (nov-c: mean 109s SD ± 22, nov-t: mean 134s SD ± 31) was found between the control and training group of the posttest.
  
  
  CONCLUSIONS
  Participants that are trained with visual force feedback produce the most secure knots in the posttest and their suturing results in lower applied forces. Therefore, the results of this study indicate that visual force feedback supports students while learning to insert the needle smoothly, to effectively align the suture threads and to balance the force between instruments during knot tying. However, for long-term learning effects, probably more than 1 training session is required.
authors.affiliation: Department of BioMechanical Engineering, Technical University Delft, Delft, The Netherlands; Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands. Electronic address: t.horeman@tudelft.nl.
authors.forename: Tim
authors.initials: T
authors.lastname: Horeman
authors.affiliation: Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Mathijs D
authors.initials: MD
authors.lastname: Blikkendaal
authors.affiliation: Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Daisy
authors.initials: D
authors.lastname: Feng
authors.affiliation: Department of BioMechanical Engineering, Technical University Delft, Delft, The Netherlands.
authors.forename: Arjan
authors.initials: A
authors.lastname: van Dijke
authors.affiliation: Department of BioMechanical Engineering, Technical University Delft, Delft, The Netherlands; Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: FrankWillem
authors.initials: F
authors.lastname: Jansen
authors.affiliation: Department of BioMechanical Engineering, Technical University Delft, Delft, The Netherlands.
authors.forename: Jenny
authors.initials: J
authors.lastname: Dankelman
authors.affiliation: Department of BioMechanical Engineering, Technical University Delft, Delft, The Netherlands.
authors.forename: John J
authors.initials: JJ
authors.lastname: van den Dobbelsteen
mesh_terms: D056228:Feedback, Sensory; D006801:Humans; D013536:Suture Techniques / Q000193:education* / Q000295:instrumentation; D013537:Sutures
keywords: Medical Knowledge; Practice-Based Learning and Improvement; interrupted sutures; medical education; training; visual force feedback