title: External validation and evaluation of an intermediate proficiency-based knot-tying and suturing curriculum.
abstract: OBJECTIVE
  The purpose of this study was to perform external validation, examine educational effectiveness, and confirm construct validity of a previously developed "intermediate-level, proficiency-based knot-tying and suturing curriculum" in preparing residents to achieve proficiency in more advanced open surgical techniques.
  
  
  METHODS
  A total of 47 postgraduate year-1 (PGY-1) surgery residents completed 6 intermediate-level knot-tying and suturing exercises. Baseline trainee performance was compared with intermediate and senior (PGY-3 and PGY-4) residents (n = 12) and expert faculty (n = 4).
  
  
  RESULTS
  PGY-1 overall proficiency increased from 21.1% at baseline to 92.1% during posttest for all 6 exercises combined (p < 0.001). When compared with the PGY-3 and PGY-4 residents, at baseline intermediate and senior residents scored higher on half of the exercises. However, during posttesting PGY-1 residents not only matched, but also surpassed PGY-3 and PGY-4 residents' performance in 3 of 6 exercises. Significant differences on all 6 exercises were also found during pretesting when comparing interns against faculty, demonstrating construct validity. However, upon completion of the curriculum, PGY-1 residents' posttest scores were equivalent, if not significantly better than expert faculty performance.
  
  
  CONCLUSIONS
  We obtained similar results as those previously reported, showing external validation. Additionally, we demonstrated that first-year surgical residents could achieve performance levels that match or exceed those of senior residents and experienced surgeons on these exercises with 4 weeks of training.
authors.affiliation: Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Electronic address: gomezpp@uthscsa.edu.
authors.forename: Pedro Pablo
authors.initials: PP
authors.lastname: Gomez
authors.affiliation: Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Ross E
authors.initials: RE
authors.lastname: Willis
authors.affiliation: School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Breanne L
authors.initials: BL
authors.lastname: Schiffer
authors.affiliation: Department of Surgery, University of Texas Southwestern, Dallas, Texas.
authors.forename: Aimee K
authors.initials: AK
authors.lastname: Gardner
authors.affiliation: Department of Surgery, University of Texas Southwestern, Dallas, Texas.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Scott
mesh_terms: D002983:Clinical Competence; D003479:Curriculum; D004503:Education, Medical, Graduate; D004521:Educational Measurement; D006801:Humans; D007396:Internship and Residency; D013536:Suture Techniques / Q000193:education*
keywords: Patient Care; Practice-Based Learning and Improvement; Systems-Based Practice; curriculum development and implementation; open knot-tying and suturing skills; proficiency-based skills training; simulation-based surgical training