To the Editor:
The COVID-19 pandemic forced universities around the world to switch to distance education with limited preparation and resources. Although the use of distance education and various e-learning materials is widely accepted in medical education, applying this way of teaching in a course that requires the use of instruments, like teaching basic surgical skills, is challenging. We aimed to establish a reproducible distance education curriculum that teaches students basic surgical skills (knot tying, suturing, and laparoscopic skills) using tools available or easily obtainable at home.
Forty-six students attended an online basic surgical skills course that included 7 online classes, 5 independent practice sessions, and an online exam. We monitored exam results and feedback from students, and we compared the outcomes with those from students in the original in-person version of the course.
During the course, students used the following household or do-it-yourself tools:
- Suture materials: shoelace, string, thread, fishing line
- Tissue under tension model for knotting: shoe, rubber band
- Easily tearing tissue model for knotting: empty can with a circle drawn around its bottom
- Needle: bent traditional sewing needle, straightened paper clip, straightened safety pin
- Needle holder: short nose, flat, knurled precision pliers (110 mm–180 mm) or similar, nail clipper
- Forceps found in most supermarkets and drugstores (e.g., eyebrow tweezers)
- Suture pad: fruits (e.g., banana, orange, tangerine), kitchen sponge, animal skin
- Pelvitrainer: any small cardboard box and a mobile phone with an application that allows it to be used as a webcam (e.g., DroidCam)
- Laparoscopic instruments: wooden spoon, any elongated object, stick
Only 3 students had trouble finding the required tools. Of the original learning objectives, students achieved 79% completely and 15% partially. Exam results were comparable with those from the previous 2 years. The students reported high satisfaction with the course especially when they considered the circumstances. They also judged the homemade tools to be an acceptable substitute given the situation.
Basic knot tying, suturing, and laparoscopic skills (except special instrument handling or laparoscopic suturing) can be taught with acceptable efficiency and student satisfaction using distance education and homemade tools.