The first stitches: what is the best teaching support ?


  1. Philine de Vries
  2. Aurelie Guenego
  3. Emilie Martin Ozanne
  4. Charles Henri David
  5. Morgan Jaffrelot
  6. Franck Ganier


7BB Approaches to teaching and learning


Université de Bretagne occidentale - psychology - Brest - France
CHRU de BREST - France
Université de Bretagne occidentale : CESIM-Santé- Brest-France


Traditionally, initial medical programs mainly include theoretical knowledge. In 1997, Kovack concluded that skill procedures should benefit from specific methods and not only be taught within the services (1). In our institution, a growing number of medical procedures are taught in manual techniques workshops. These workshops leave the students only very little time to train. Online learning materials could provide them an opportunity to practice by themselves.

Animations should be a teaching support to enable all students to practice basic skills. However, the literature is not unanimous on the benefit of animation compared to static pictures (2).

We set up a study to highlight the best media usable for students to achieve the first stitch.

Summary of Work

48 volunteer students, in the second year of medical school, were divided in three groups, and faced with one of the three experimental conditions: “pictures + text”, “video + Audio”, “video + text”. They had to perform five stitches.

Individually, the students were familiarised with the software used to present the instructions. They were asked to study prerequisites for carrying out sutures : presentation of equipment, placing the needle in the needle holder and some errors to be avoided. At this point, they were given access to the videos or the pictures instructing them how to suture.

When a stitch was completed, it was evaluated using the OSATS Scale (3).

Data analysis focused on time measurements: time to complete the task, time spent consulting the instructions, time spent carrying out the actions; and on performance measurements: quality of the knots for each of the five trials.

Statistical analysis: results were expressed as mean +/- error standard of the mean. Statistical differences were determined by analysis of variance (ANOVA) followed by post hoc test. p<0.05 were considered statistically significant

Take-home Messages

Three instruction supports were compared for learning manual techniques.

These supports were: photographs + text, video + text, and video + audio.

The videos resulted in better performance levels than the photographs for the first trial.

For the following trials, the photographs were more effective in terms of speed.

Where quality was concerned, the photographs format systematically resulted in better performance levels.


(1) Kovack G. Procedural skills in medicine: linking theory to practice. J. Emerg med. 1997 May;15(3):387-91

(2) Berney, S, Thiriet, P. & Hoyek, N. (2014). Quel rôle pour les supports multimédias dans un contexte d'apprentissage ? De la naissance à la validation scientifique d'une ingénierie pédagogique. In G. Lameul & C. Loisy (Eds.),

(3) Martin, J. A., Regehr, G., Reznick, R., MacRae, H., Murnaghan, J., Hutchison, C., & Brown, M. (1997). Objective structured assessment of technical skill (OSATS) for surgical residents. British Journal of Surgery, 84, 273-278.

(4) Ganier, F., & Querrec, R. (2012). TIP-EXE: A software tool for studying the use and understanding of procedural documents. IEEE Transactions on Professional Communication, 55, 106-121.

Summary of Results

Figure 1 and 2 : Video support and Pictures support: The participants were able to pause and resume video playback at their convenience by clicking on the video. The photographs were presented in a TIP-EXE software, which allows for displaying previously blurred images (4). To make these images visible, the participants had to click on them, which allowed for recording the duration of consultation of each image.


Figure 3 : Time spent consulting the instrutions: The time measurements related to the completion of the task took the form of a classic learning curve. On the first try, the "video-sound" support was significantly shorter consulted. However, from the second trial the condition "photo-text" was significantly shorter consulted.


Figure 4: Quality of the stitchs (OSATS score) depending on the number of trial and pedagogical support: The performance of the participants followed the classic learning curve: increasing quality of the stitches. The "photo-text" support was significantly more effective when the performances were compared, using OSATS assessment.


Video improves learning speed during the discovery phase of the procedure whereas static pictures are a better learning support to create stronger mental schemas. The use of new technologies in medical education can help us, as long as we identify their strengths and weaknesses.

Summary of Work
Take-home Messages
Summary of Results

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