Virtual suturing skills learning: role of verbal versus written feedback in surgery rotation clerkship

Objective: Onsite clinical skills learning is interrupted during the SARS-CoV-2 pandemic. This study aimed to compare the effectiveness of verbal versus written feedback in virtual suturing skills learning.

Design: Participants were randomly divided into two groups, one with verbal feedback and written feedback on the other. Each was instructed to perform a simple interrupted suture which was assessed both before (pre-test) and after (post-test) feedback was given. Both groups were given the same duration of time to learn from the feedback they received.

Setting: Students undergoing clinical rotation in Department of Surgery at School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia.

Participants: The eligibility of the participants are students who enrolled on virtual learning in the surgery rotation and have consented to the research and those who own basic surgical equipment at home. A total of 199 participants were enrolled, with 17 (8.55%) participants dropping out.

Results: Out of 182 participants, 66 (36.3%) were males and 116 (63.7%) were females. The group receiving verbal intervention showed a significant difference both in suturing skills checklist (Pre-test [M = 4.11, SD = 0.61] and post-test [M = 4.73, SD = 0.37]; t(85) = -10.63, p = 0.000) and Global Rating Scale (GRS) assessment (pre-test [M = 3.83, SD = 1.06] and post-test [M = 4.56, SD = 0.64]; t(86) = -8.10, p = 0.000). In the same way, the group receiving written intervention also showed a significant mean pre-test and pos-test difference in both assessment tools (Checklist assessment [Z = -7.93, p = 0.000]; GRS assessment pre-test [M = 3.42, SD = 0.73] and post-test [M = 4.20, SD = 0.83]; t(105) = -9.62, p = 0.000). Both verbal and written feedback had a large effect (effect size >0.8).

Conclusions: Both verbal and written feedback provide a significant result in improving suturing skills in a virtual learning setting which may provide a solution to online clinical skills training.