An Educational Network for Surgical Education Supported by Gamification Elements: Protocol for a Randomized Controlled Trial

Natasha Guérard-Poirier, Michèle Beniey, Léamarie Meloche-Dumas, Florence Lebel-Guay, Bojana Misheva, Myriam Abbas, Malek Dhane, Myriam Elraheb, Adam Dubrowski, Erica Patocskai, Natasha Guérard-Poirier, Michèle Beniey, Léamarie Meloche-Dumas, Florence Lebel-Guay, Bojana Misheva, Myriam Abbas, Malek Dhane, Myriam Elraheb, Adam Dubrowski, Erica Patocskai

Abstract

Background: Traditionally, medical students have learned surgical skills by observing a resident physician or surgeon who is performing the technique. Due to inconsistent practice opportunities in the clinical setting, a disparity of skill levels among students has been observed. In addition, the poor availability of faculty professors is a limiting factor in teaching and adequately preparing medical students for their clerkship years. With the ongoing COVID-19 pandemic, medical students do not have access to traditional suturing learning opportunities. Didactic courses are available on videoconferencing platforms; however, these courses do not include technical training.

Objective: Our overarching goal is to evaluate the efficacy and usability of web-based peer-learning for advanced suturing techniques (ie, running subcuticular sutures). We will use the Gamified Educational Network (GEN), a newly developed web-based learning tool. We will assess students' ability to identify and perform the correct technique. We will also assess the students' satisfaction with regard to GEN.

Methods: We will conduct a prospective randomized controlled trial with blinding of expert examiners. First-year medical students in the Faculty of Medicine of Université de Montréal will be randomized into four groups: (1) control, (2) self-learning, (3) peer-learning, and (4) peer-learning with expert feedback. Each arm will have 15 participants who will learn how to perform running subcuticular sutures through videos on GEN. For our primary outcome, the students' ability to identify the correct technique will be evaluated before and after the intervention on GEN. The students will view eight videos and rate the surgical techniques using the Objective Structured Assessment of Technical Skills Global Rating Scale and the Subcuticular Suture Checklist as evaluation criteria. For our secondary outcomes, students will anonymously record themselves performing a running subcuticular suture and will be evaluated using the same scales. Then, a survey will be sent to assess the students' acceptance of the intervention.

Results: The study will be conducted in accordance with the Declaration of Helsinki and has been approved by our institutional review board (CERSES 20-068-D). No participants have been recruited yet.

Conclusions: Peer learning through GEN has the potential to overcome significant limitations related to the COVID-19 pandemic and the lack of availability of faculty professors. Further, a decrease of the anxiety related to traditional suturing classes can be expected. We aim to create an innovative and sustainable method of teaching surgical skills to improve the efficiency and quality of surgical training in medical faculties. In the context of the COVID-19 pandemic, the need for such tools is imperative.

Trial registration: ClinicalTrials.gov NCT04425499; https://ichgcp.net/clinical-trials-registry/NCT04425499.

International registered report identifier (irrid): PRR1-10.2196/21273.

Keywords: COVID-19; advanced sutures; distance learning; gamification; learning platform; medical education; medical student; peer learning; subcuticular sutures; surgery; surgical pedagogy; video; web-based learning; web-based tool.

Conflict of interest statement

Conflicts of Interest: None declared.

©Natasha Guérard-Poirier, Michèle Beniey, Léamarie Meloche-Dumas, Florence Lebel-Guay, Bojana Misheva, Myriam Abbas, Malek Dhane, Myriam Elraheb, Adam Dubrowski, Erica Patocskai. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 14.12.2020.

Figures

Figure 1
Figure 1
Study workflow. GEN: Gamified Educational Network; GRS: Global Rating Score.

References

    1. Davis CR, Toll EC, Bates AS, Cole MD, Smith FC. Surgical and procedural skills training at medical school - a national review. Int J Surg. 2014 Aug;12(8):877–82. doi: 10.1016/j.ijsu.2014.05.069.
    1. Graziano SC. Randomized surgical training for medical students: resident versus peer-led teaching. Am J Obstet Gynecol. 2011 Jun;204(6):542.e1–4. doi: 10.1016/j.ajog.2011.01.038.
    1. Seo HS, Eom YH, Kim MK, Kim Y, Song BJ, Song KY. A one-day surgical-skill training course for medical students' improved surgical skills and increased interest in surgery as a career. BMC Med Educ. 2017 Dec 28;17(1):265. doi: 10.1186/s12909-017-1106-x.
    1. Manning EP, Mishall PL, Weidmann MD, Flax H, Lan S, Erlich M, Burton WB, Olson TR, Downie SA. Early and prolonged opportunities to practice suturing increases medical student comfort with suturing during clerkships: Suturing during cadaver dissection. Anat Sci Educ. 2018 Nov;11(6):605–612. doi: 10.1002/ase.1785.
    1. Hammond I, Karthigasu K. Training, assessment and competency in gynaecologic surgery. Best Pract Res Clin Obstet Gynaecol. 2006 Feb;20(1):173–87. doi: 10.1016/j.bpobgyn.2005.09.006.
    1. Wang TS, Schwartz JL, Karimipour DJ, Orringer JS, Hamilton T, Johnson TM. An education theory-based method to teach a procedural skill. Arch Dermatol. 2004 Nov;140(11):1357–61. doi: 10.1001/archderm.140.11.1357.
    1. Speer DP. The influence of suture technique on early wound healing. J Surg Res. 1979 Dec;27(6):385–391. doi: 10.1016/0022-4804(79)90158-6.
    1. Denadai R, Toledo AP, Oshiiwa M, Saad-Hossne R. Acquisition of suture skills during medical graduation by instructor-directed training: a randomized controlled study comparing senior medical students and faculty surgeons. Updates Surg. 2013 Jun 13;65(2):131–40. doi: 10.1007/s13304-013-0199-y.
    1. Preece R, Dickinson EC, Sherif M, Ibrahim Y, Ninan AS, Aildasani L, Ahmed S, Smith P. Peer-assisted teaching of basic surgical skills. Med Educ Online. 2015 Jun 03;20(1):27579. doi: 10.3402/meo.v20.27579.
    1. Safir O, Williams CK, Dubrowski A, Backstein D, Carnahan H. Self-directed practice schedule enhances learning of suturing skills. Can J Surg. 2013 Dec 1;56(6):E142–7. doi: 10.1503/cjs.019512.
    1. Gallagher KC, Matevish LE, Neuzil K, Evans PT, Eastham SC, Terhune KP, Eskind SJ. Peer-led Surgical Clerkship Programming Support Through the General Surgery Interest Group at the Vanderbilt University School of Medicine. J Surg Educ. 2019;76(6):1451–1455. doi: 10.1016/j.jsurg.2019.04.012.
    1. González R, Molina H, García-Huidobro M, Stevens P, Jadue A, Riquelme A, Torres J, Barra S, Alarcón F, Fasce E. Basic suture techniques for medicine students: comparative results according to training by surgeons versus peers. CIRU. 2019 Oct 17;87(6) doi: 10.24875/ciru.18000771.
    1. Kim MJ, Boehler ML, Ketchum JK, Bueno R, Williams RG, Dunnington GL. Skills coaches as part of the educational team: a randomized controlled trial of teaching of a basic surgical skill in the laboratory setting. Am J Surg. 2010 Jan;199(1):94–8. doi: 10.1016/j.amjsurg.2009.08.016.
    1. Saleh M, Sinha Y, Weinberg D. Using peer-assisted learning to teach basic surgical skills: medical students' experiences. Med Educ Online. 2013 Aug 22;18(1):21065. doi: 10.3402/meo.v18i0.21065.
    1. Gershuni V, Woodhouse J, Brunt LM. Retention of suturing and knot-tying skills in senior medical students after proficiency-based training: Results of a prospective, randomized trial. Surgery. 2013 Oct;154(4):823–9; discussion 829. doi: 10.1016/j.surg.2013.07.016.
    1. Hu Y, Choi J, Mahmutovic A, Kim H, Le IA, Rasmussen SK. Assistant instructors facilitate simulation for medical students. J Surg Res. 2015 Apr;194(2):334–340. doi: 10.1016/j.jss.2014.11.047.
    1. Weyrich P, Celebi N, Schrauth M, Möltner A, Lammerding-Köppel M, Nikendei C. Peer-assisted versus faculty staff-led skills laboratory training: a randomised controlled trial. Med Educ. 2009 Feb;43(2):113–20. doi: 10.1111/j.1365-2923.2008.03252.x.
    1. Van Bruwaene S, De Win G, Miserez M. How much do we need experts during laparoscopic suturing training? Surg Endosc. 2009 Dec 15;23(12):2755–61. doi: 10.1007/s00464-009-0498-z.
    1. Gentry SV, Gauthier A, L'Estrade Ehrstrom B, Wortley D, Lilienthal A, Tudor Car L, Dauwels-Okutsu S, Nikolaou CK, Zary N, Campbell J, Car J. Serious Gaming and Gamification Education in Health Professions: Systematic Review. J Med Internet Res. 2019 Mar 28;21(3):e12994. doi: 10.2196/12994.
    1. Ohn M, Ohn K. An evaluation study on gamified online learning experiences and its acceptance among medical students. Ci Ji Yi Xue Za Zhi. 2020;32(2):211–215. doi: 10.4103/tcmj.tcmj_5_19.
    1. Felszeghy S, Pasonen-Seppänen S, Koskela A, Nieminen P, Härkönen K, Paldanius KMA, Gabbouj S, Ketola K, Hiltunen M, Lundin M, Haapaniemi T, Sointu E, Bauman EB, Gilbert GE, Morton D, Mahonen A. Using online game-based platforms to improve student performance and engagement in histology teaching. BMC Med Educ. 2019 Jul 22;19(1):273. doi: 10.1186/s12909-019-1701-0.
    1. McCoy L, Lewis JH, Dalton D. Gamification and Multimedia for Medical Education: A Landscape Review. J Am Osteopath Assoc. 2016 Jan 01;116(1):22–34. doi: 10.7556/jaoa.2016.003.
    1. Torkington J, Smith SG, Rees BI, Darzi A. The role of simulation in surgical training. Ann R Coll Surg Engl. 2000 Mar;82(2):88–94.
    1. Milburn J, Khera G, Hornby S, Malone P, Fitzgerald J. Introduction, availability and role of simulation in surgical education and training: review of current evidence and recommendations from the Association of Surgeons in Training. Int J Surg. 2012;10(8):393–8. doi: 10.1016/j.ijsu.2012.05.005.
    1. Dubrowski A, Xeroulis G. Computer-based video instructions for acquisition of technical skills. J Vis Commun Med. 2005 Dec;28(4):150–5. doi: 10.1080/01405110500518622.
    1. Nousiainen M, Brydges R, Backstein D, Dubrowski A. Comparison of expert instruction and computer-based video training in teaching fundamental surgical skills to medical students. Surgery. 2008 Apr;143(4):539–44. doi: 10.1016/j.surg.2007.10.022.
    1. Yang Y, Shulruf B. Expert-led and artificial intelligence (AI) system-assisted tutoring course increase confidence of Chinese medical interns on suturing and ligature skills: prospective pilot study. J Educ Eval Health Prof. 2019 Apr 10;16:7. doi: 10.3352/jeehp.2019.16.7. doi: 10.3352/jeehp.2019.16.7.
    1. Moulton CE, Dubrowski A, Macrae H, Graham B, Grober E, Reznick R. Teaching surgical skills: what kind of practice makes perfect?: a randomized, controlled trial. Ann Surg. 2006 Sep;244(3):400–9. doi: 10.1097/01.sla.0000234808.85789.6a.
    1. Abbas M. Repercussions of the COVID-19 pandemic on the well-being and training of medical clerks: a pan-Canadian survey. BMC Med Educ. 2020;20(1):a.
    1. Akers A, Blough C, Iyer MS. COVID-19 Implications on Clinical Clerkships and the Residency Application Process for Medical Students. Cureus. 2020 Apr 23;12(4):e7800. doi: 10.7759/cureus.7800.
    1. Goldenberg MN, Hersh DC, Wilkins KM, Schwartz ML. Suspending Medical Student Clerkships Due to COVID-19. Med Sci Educ. 2020 Jun 03;30(3):1–4. doi: 10.1007/s40670-020-00994-1.
    1. Durfee SM, Goldenson RP, Gill RR, Rincon SP, Flower E, Avery LL. Medical Student Education Roadblock Due to COVID-19: Virtual Radiology Core Clerkship to the Rescue. Acad Radiol. 2020 Oct;27(10):1461–1466. doi: 10.1016/j.acra.2020.07.020.
    1. Faulkner H, Regehr G, Martin J, Reznick R. Validation of an objective structured assessment of technical skill for surgical residents. Acad Med. 1996 Dec;71(12):1363–5. doi: 10.1097/00001888-199612000-00023.
    1. Reznick R, Regehr G, MacRae H, Martin J, McCulloch W. Testing technical skill via an innovative “bench station” examination. Am J Surg. 1997 Mar;173(3):226–230. doi: 10.1016/s0002-9610(97)89597-9.
    1. Brooke J. SUS: A Retrospective. J Usability Stud. 2013 Feb;8(2):29–40.
    1. RStudio. [2020-12-08]. .
    1. Prism. GraphPad. [2020-12-09].
    1. Del Blanco Á, Torrente J, Fernández-Manjón B, Ruiz P, Giner M. Using a videogame to facilitate nursing and medical students' first visit to the operating theatre. A randomized controlled trial. Nurse Educ Today. 2017 Aug;55:45–53. doi: 10.1016/j.nedt.2017.04.026.
    1. Pavlidis I, Zavlin D, Khatri AR, Wesley A, Panagopoulos G, Echo A. Absence of Stressful Conditions Accelerates Dexterous Skill Acquisition in Surgery. Sci Rep. 2019 Feb 11;9(1):1747. doi: 10.1038/s41598-019-38727-z. doi: 10.1038/s41598-019-38727-z.

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