Comparison of expert instruction and computer-based video training in teaching fundamental surgical skills to medical students Markku Nousiainen, MD, MS, FRCS(C), Ryan Brydges, MSc, David Backstein, MD, MEd, FRCS(C), and Adam Dubrowski, PhD, Toronto, Ontario Background. Practice using computer-based video instruction (CBVI) leads to improvements in surgical skills proficiency. This study investigated the benefits of the introduction of (a) learner-directed, interactive video training and (b) the addition of expert instruction on the learning and retention of the basic surgical skills of suturing and knot-tying in medical students. Methods. Using bench models, students were pre-tested on a suturing and knot-tying skill after viewing an instructional video. The students were then randomly assigned to three practice conditions: self-study with video; self-study with interactive video; or the combination of self-study with interactive video with the addition of subsequent expert instruction. All participants underwent 18 trials of practice in their assigned training condition. The effectiveness of training was assessed by an immediate post-test and a retention test one month later. Performance was evaluated using expert- and computer-based assessments. Data were analyzed using repeated-measures ANOVA. Results. There were no differences in expert- and computer-based assessments between groups at pre-test. Although all three groups demonstrated significant improvements on both measures between the pre- and post-tests as well as between pre-tests and retention-tests (P < .01), no significant differences were detected among the three groups. Conclusion. This study shows that in surgical novices, neither the inclusion of expert instruction nor the addition of self-directed interaction with video leads to further improvements in skill development or retention. These findings further support the possible implementation of CBVI within surgical skills curricula. (Surgery 2008;143:539-44.) From the Department of Surgery and the Wilson Centre for Research in Education, University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada THE ACQUISITION of technical surgical skills by medical students involves didactic instruction, practice, and feedback, which often consume con- siderable faculty teaching time. As a result, there is increasing advocacy among medical educators for the use of novel teaching methods that utilize computer-based training and bench models. 1-3 The benefits of these technologies include decreased time demands on faculty and flexible opportunities for students to learn, practice, and acquire proficiency in new skills without clinical pressures. Proper implementation of these novel teaching methods may alleviate some of the strains associated with teaching large undergraduate medical classes as well as junior surgical and medical residents. Computer-based video instruction (CBVI) shows promise of becoming an indispensable adjunct to the teaching of basic surgical skills. It has been recently demonstrated that under prescribed practice conditions, CBVI is equally effective as faculty instruction in teaching basic surgical skills to medical students. 4,5 The immedi- ate implication of these findings to medical education is that approaches relying on CBVI may be distributed to students and residents for self-directed learning of fundamental surgical skills. In accordance with a recently proposed trained-novice framework, 6 instructor resources, Supported in part by the Dean’s Excellence Fund, Department of Surgery, University of Toronto. Accepted for publication October 25, 2007. Reprint requests: Dr. Adam Dubrowski, University of Toronto, Department of Surgery, Wilson Centre, 200 Elizabeth St., Eaton South IE 583, Toronto, Ontario, Canada M5G 2C5. E-mail: adam.dubrowski@gmail.com. 0039-6060/$ - see front matter Ó 2008 Mosby, Inc. All rights reserved. doi:10.1016/j.surg.2007.10.022 SURGERY 539