TASSL Curricula - Basic Open Knot-Tying and Suturing Skills Training Program

 

List of Tasks

  1. Palming the needle driver
  2. Knot-tying, no tension, 2-handed
  3. Knot-tying, no tension, 1-handed
  4. Knot-tying, under tension, 2-handed, surgeon's knot
  5. Knot-tying, under tension, 2-handed, slip knot
  6. Knot-tying, under tension, 1-handed, slip knot
  7. Suturing, interrupted, simple
  8. Suturing, interrupted, horizontal mattress
  9. Suturing, interrupted, vertical mattress
  10. Suturing, running, simple
  11. Suturing, running, subcuticular
  12. Suturing, interrupted, subcuticular

Proficiency and Scoring

The Basic Open Skills Training Program is based on the concept of proficiency-based training, which recognizes the fact that learners progress at different rates. As such, individuals train to a mastery goal, rather than for a specified period of time. That is, learning time is allowed to vary among learners, but achievement is not. Learners are allowed to practice each skill as many times as necessary to achieve the designated mastery criterion listed below. The table below indicates the mastery criteria designated for each task.

Task Target Time (seconds) Maximum
Time Allotment (seconds)		 Errors Required Proficiency Score
1 Palming the needle driver 7 60 Non-closure, accuracy, instrument drop, non-palming 53 (7 seconds, no errors)
2 Knot-tying, no tension, 2-handed 10 60 Knot accuracy, gap, slippage, breakage 50 (10 seconds, no errors)
3 Knot-tying, no tension, 1-handed 10 60 Knot accuracy, gap, slippage, breakage 50 (10 seconds, no errors)
4 Knot-tying, under tension, 2-handed, surgeon's knot 13 60 Knot accuracy, gap, slippage, breakage 47 (13 seconds, no errors)
5 Knot-tying, under tension, 2-handed, slip knot 15 60 Knot accuracy, gap, slippage, breakage 45 (15 seconds, no errors)
6 Knot-tying, under tension, 1-handed, slip knot 15 60 Knot accuracy, gap, slippage, breakage 45 (15 seconds, no errors)
7 Suturing, interrupted, simple 18 120 Knot accuracy, gap, slippage, breakage, non-palming, needle loading 102 (18 seconds, no errors)
8 Suturing, interrupted, horizontal mattress 31 120 Knot accuracy, gap, slippage, breakage, non-palming, needle loading 89 (31 seconds, no errors)
9 Suturing, interrupted, vertical mattress 31 120 Knot accuracy, gap, slippage, breakage, non-palming, needle loading 89 (31 seconds, no errors)
10 Suturing, running, simple 165 600 Knot accuracy, gap, slippage, breakage, non-palming, needle loading 435 (165 seconds, no errors)
11 Suturing, running, subcuticular 204 600 Knot accuracy, gap, slippage, breakage, non-palming, needle loading 396 (204 seconds, no errors)
12 Suturing, interrupted, subcuticular 33 120 Knot accuracy, gap, slippage, breakage, non-palming, needle loading 87 (33 seconds, no errors)

 

ProficiencyScore = MaxTimeAllotment - Time - (10 X Errors)

Scoring Example: If you performed Task 2 in 12 seconds and the knot had a gap (a.k.a. "air knot"), then your proficiency score would be:

ProficiencyScore = 60 - 12 - (10 X 1)
ProficiencyScore = 60 - 12 - 10
ProficiencyScore = 38 (failure to demonstrate proficiency)

Your proficiency score must be greater than the required proficiency score on 2 consecutive trials before moving to the next task in the progression.

Files

Protocol

  1. Trainee completes the pretest questionnaire.
  2. Trainee completes baseline testing. This consists of one trial of each of the 12 tasks. Scores are recorded on the worksheets provided in the file "Open Basic Score Sheets.xls".
  3. Trainee trains to proficiency on each of the 12 tasks. Scores are recorded on the worksheets provided in the file "Open Basic Score Sheets.xls".
  4. Trainee completes posttesting. This consists of one trial of each of the 12 tasks. Scores are recorded on the worksheets provided in the file "Open Basic Score Sheets.xls".
  5. Trainee completes the posttest questionnaire.

References
Goova, M.T., Hollett, L.A., Tesfay, S.T., Gala, R.B., Puzziferri, N., Hehdy, F.J., Scott, D.J. (2008). Implementation, construct validity, and benefit of a proficiency-based knot-tying and suturing curriculum. Journal of Surgical Education, 65, 309-315.

Scott, D.J., Goova, M.T., & Tesfay, S.T. (2007). A cost-effective proficiency-based knot-tying and suturing curriculum for residency programs. Journal of Surgical Research, 141, 7-15.