title: A better way to teach knot tying: a randomized controlled trial comparing the kinesthetic and traditional methods.
abstract: BACKGROUND
  Knot tying is a fundamental and crucial surgical skill. We developed a kinesthetic pedagogical approach that increases precision and economy of motion by explicitly teaching suture-handling maneuvers and studied its effects on novice performance.
  
  
  METHODS
  Seventy-four first-year medical students were randomized to learn knot tying via either the traditional or the novel "kinesthetic" method. After 1 week of independent practice, students were videotaped performing 4 tying tasks. Three raters scored deidentified videos using a validated visual analog scale. The groups were compared using analysis of covariance with practice knots as a covariate and visual analog scale score (range, 0 to 100) as the dependent variable. Partial eta-square was calculated to indicate effect size.
  
  
  RESULTS
  Overall rater reliability was .92. The kinesthetic group scored significantly higher than the traditional group for individual tasks and overall, controlling for practice (all P < .004). The kinesthetic overall mean was 64.15 (standard deviation = 16.72) vs traditional 46.31 (standard deviation = 16.20; P < .001; effect size = .28).
  
  
  CONCLUSIONS
  For novices, emphasizing kinesthetic suture handling substantively improved performance on knot tying. We believe this effect can be extrapolated to more complex surgical skills.
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, 513 Parnassus Avenue, S-321, San Francisco, CA 94143-0470, USA. Electronic address: emily.huang2@ucsfmedctr.org.
authors.forename: Emily
authors.initials: E
authors.lastname: Huang
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, 513 Parnassus Avenue, S-321, San Francisco, CA 94143-0470, USA.
authors.forename: Hueylan
authors.initials: H
authors.lastname: Chern
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: O'Sullivan
authors.affiliation: School of Medicine, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Cook
authors.affiliation: School of Medicine, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Erik
authors.initials: E
authors.lastname: McDonald
authors.affiliation: Department of Surgery, University of California, San Francisco-East Bay, Oakland, CA, USA.
authors.forename: Barnard
authors.initials: B
authors.lastname: Palmer
authors.affiliation: Department of Surgery, University of California, San Francisco-East Bay, Oakland, CA, USA.
authors.forename: Terrence
authors.initials: T
authors.lastname: Liu
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, 513 Parnassus Avenue, S-321, San Francisco, CA 94143-0470, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Kim
mesh_terms: D002983:Clinical Competence; D004501:Education, Medical / Q000379:methods*; D006801:Humans; D008511:Medicine / Q000592:standards*; D015203:Reproducibility of Results; D012495:San Francisco; D012577:Schools, Medical; D013337:Students, Medical; D013536:Suture Techniques / Q000193:education*; D013537:Sutures / Q000592:standards*
keywords: Basic skills; Kinesthetic; Knot tying; Skill; Surgical education; Technical