Remote Video-Delivered Suturing Education with Smartphones: A Non-Inferiority Randomized Controlled Trial

Objective: To measure remote feedback's educational benefit, assess its perceived feasibility and utility, and demonstrate implementation of a practical and cost-effective model. Design: Medical students were randomized to receive live video- or recorded video-delivered feedback on suturing skills. A non-randomized control group received in-person feedback. Pre- and post-feedback recordings of suturing were evaluated by blinded assessors to determine improvement using the University of Bergen suturing skills assessment tool (UBAT) and Objective Structured Assessment of Technical Skills (OSATS). Study arms were compared to the control arm in a non-inferiority analysis. Participants and feedback providers completed questionnaires regarding feasibility and utility of their feedback modality. Participants Fifty-four first- and second-year medical student participants and 11 surgical resident feedback providers McMaster University. Results: UBAT score change was 40.5 in the remote live video feedback group, 8.7 in the remote recorded video feedback group, and 18.0 in the in-person feedback group with no significant difference between groups (p=0.619). However, 95% confidence intervals did not exclude a non-inferiority threshold for either video-based experimental arm. Similar findings were demonstrated using the OSATS tool. Questionnaire responses found that participants and feedback providers both rated video-delivered feedback as feasible and useful. Conclusions: There was no significant difference in learner improvement between live or recorded video-delivered feedback and in-person feedback, but non-inferiority was not established. We have demonstrated subjective feasibility and utility of a highly-accessible and affordable model of remote video-delivered feedback in technical skills acquisition.