Teaching Medical Students to Suture: Evaluation of a Modern Medical School Curriculum

Background: Medical students are traditionally introduced to suturing in a simulated environment using animal products or synthetic materials. However, there is little evidence to support this pedagogy. Our study explored whether a modern suturing curriculum adequately prepares medical students and examined   student preference for learning suturing skills.   Methods: Suturing performance was recorded and assessed by expert raters. Students also completed a survey that inquired about self-perceived knowledge and confidence in suturing, and preferred pedagogical methods.   Results: The majority (79%) of students that completed our suturing curriculum demonstrated competence in basic suturing techniques. There was no correlation between objective abilities and self-perceived knowledge or confidence. Students reported being significantly more confident suturing anesthetized patients and in simulated environments. Students reported a desire for earlier introduction to suturing and more frequent simulation training.   Conclusion: A modern medical school suturing curriculum, comprising online modules and in-person simulation-based learning, adequately develops basic suturing techniques.

Characteristics and outcomes of patients with COVID-19 admitted to hospital and intensive care in the first phase of the pandemic in Canada: a national cohort study

BACKGROUND

Clinical data on patients admitted to hospital with coronavirus disease 2019 (COVID-19) provide clinicians and public health officials with information to guide practice and policy. The aims of this study were to describe patients with COVID-19 admitted to hospital and intensive care, and to investigate predictors of outcome to characterize severe acute respiratory infection.

METHODS

This observational cohort study used Canadian data from 32 selected hospitals included in a global multisite cohort between Jan. 24 and July 7, 2020. Adult and pediatric patients with a confirmed diagnosis of COVID-19 who received care in an intensive care unit (ICU) and a sampling of up to the first 60 patients receiving care on hospital wards were included. We performed descriptive analyses of characteristics, interventions and outcomes. The primary analyses examined in-hospital mortality, with secondary analyses of the length of hospital and ICU stay.

RESULTS

Between January and July 2020, among 811 patients admitted to hospital with a diagnosis of COVID-19, the median age was 64 (interquartile range [IQR] 53-75) years, 495 (61.0%) were men, 46 (5.7%) were health care workers, 9 (1.1%) were pregnant, 26 (3.2%) were younger than 18 years and 9 (1.1%) were younger than 5 years. The median time from symptom onset to hospital admission was 7 (IQR 3-10) days. The most common symptoms on admission were fever, shortness of breath, cough and malaise. Diabetes, hypertension and cardiac, kidney and respiratory disease were the most common comorbidities. Among all patients, 328 received care in an ICU, admitted a median of 0 (IQR 0-1) days after hospital admission. Critically ill patients received treatment with invasive mechanical ventilation (88.8%), renal replacement therapy (14.9%) and extracorporeal membrane oxygenation (4.0%); 26.2% died. Among those receiving mechanical ventilation, 31.2% died. Age was an influential predictor of mortality (odds ratio per additional year of life 1.06, 95% confidence interval 1.03-1.09).

INTERPRETATION

Patients admitted to hospital with COVID-19 commonly had fever, respiratory symptoms and comorbid conditions. Increasing age was associated with the development of critical illness and death; however, most critically ill patients in Canada, including those requiring mechanical ventilation, survived and were discharged from hospital.