Suture Training: Better Skill Transfer With Simulation-Based Learning

higher fidelity simulators improve skill transfer in suture training

Unfortunately, too many medical students finish their training without adequate opportunities to practice basic surgical skills effectively. Too often, the instructional model relies on either subpar materials, one-off instruction or insufficient hands-on practice. Without the opportunity for simulation-based learning, students may finish their training lacking the confidence and technical skills to effectively treat patients.

Simple observation is not an ideal instructional model for students to master the basic surgical skills necessary to perform their jobs well. Watching an instructor perform a procedure is certainly necessary as a first step, but skipping directly from observation to practice on a patient is an avoidable and high-stakes leap in training. 

Instead, students should be provided with opportunities for simulation-based practice, and ideally their instruction should unfold over time. Studies have shown that simulation-based instruction with high-fidelity simulators is an effective method for improving students’ confidence and retention of skills. 

Practicing suture techniques on pigs’ feet or banana peels is certainly better than not practicing at all. However, those sample tissues lack the realism necessary to ensure students are prepared for real-world performance of surgical techniques. As such, they fall into the category of low-fidelity simulation, which is a less than ideal option for medical training.

Fidelity is ranked by the degree to which a simulator mimics the real-life experience of performing a procedure. This, in turn, connects to the transferability of skills in a real-life setting with live patients. The higher the fidelity of the simulator, the more effective it will be as a training tool for students. 

Low-fidelity simulators consist of materials that are typically immobile and unrealistic. Examples include basic mannequins and sample tissues that are unable to mimic reality. Again, practicing on low-fidelity simulators is a better alternative than moving directly to practicing on patients, but it fails to provide the realism that will help students be prepared for transitioning to real world procedures.

In contrast, higher fidelity simulators use more realistic and complex materials, providing a more true-to-life experience for the student. These types of simulators strive to achieve greater realism by offering more accurate visual and haptic experiences for the user. Higher fidelity simulators include tools such as an ingrown toenail simulator that looks and feels like a human toe or a vascular access sleeve that allows students to practice drawing blood on a living human without having to actually pierce a vein.

Higher fidelity simulation has been shown to result in a statistically significant increase in skill transfer. Sidhu et al1 demonstrated that students given the opportunity to practice on high-fidelity endovascular simulators achieved a markedly higher level of technical performance than those who practiced on low-fidelity simulators. Similarly, Brydges et al2 found that students trained by working on progressively higher-fidelity simulators achieved notably better skill transfer. Additionally, a study3 involving high-fidelity simulations of an obstructed airway found that high-fidelity training resulted in students successfully performing their task more quickly.  

Ultimately, using high-fidelity simulation decreases the learning curve by emphasizing realism and helps students to achieve proficiency prior to working on a live patient. As Amin et al4 note, “high-fidelity simulation allows for the ability to perform a greater volume of cases… [and] without the risk of potential harm to the patient, trainees can focus on repetition and improved performance in a stress-free environment.”

  1. Sidhu RS, Park J, Brydges R, et al: Laboratory-based vascular anastomosis training: A randomized controlled trial evaluating the effects of bench model fidelity and level of training on skill acquisition. J Vasc Surg 45:343-349, 2007.
  2. Brydges R, Carnahan H, Rose D, et al: Coordinating progressive levels of simulation fidelity to maximize educational benefit. Acad Med 85:806-812, 2010.
  3. Mills BW, Carter OB, Rudd CJ, et al: Effects of Low- Versus High-Fidelity Simulations on the Cognitive Burden and Performance of Entry-Level Paramedicine. Students Simul Healthc 11(1):10-8, 2016.
  4. Amin A, Salsamendi J, Sullivan T: High-Fidelity Endovascular Simulation. Tech Vasc Interventional Rad 22:7-13, 2018.