Student Organizes Suture Skills Lab to Help Classmates Prepare for Clerkships

By Vivian Mason

How does a medical student become an expert at suturing? By practicing, of course. The primary goals of suturing are to close a wound, repair tissue, and facilitate healing. For Navy Ensign Emily Raffetto, a second-year medical student at Uniformed Services University’s (USU) F. Edward Hébert School of Medicine (SOM), the suture skills labs are something she looks forward to.

Navy Ensigns Tahler Bandarra, Amanda Lu, and James Hoang work on
perfecting their surgical suturing techniques during a recent surgical
skills lab at USU. (Image credit: Sharon Holland)

Raffetto acts as the Surgery Skills Coordinator for USU’s Surgery Interest Group (SIG), which gives students exposure to the field of surgery.  “I plan, schedule, and coordinate the suture skills labs,” she notes. “I’m responsible for the materials and make sure we keep up with everything. Sutures are very expensive, so we rely on expired sutures that have been donated to us from my former employer.” Before attending USU, Raffetto worked as a surgical technician for a dermatologist who was a Mohs surgeon (physician who removes skin cancer tissue). She revealed, “My job included numbing, prepping, setting up a sterile field, and getting everything ready for the surgeon. During the suturing process, I made sure that he had the necessary sutures, helped him as he closed the wound, compiled notes, and acted as scribe. I learned a lot.” Raffetto added that with his mentoring, “I kept practicing suturing on my oranges and ‘fake skin’ [silicone], as well as getting valuable experience using expired sutures.”

The suture labs consist of 30 students who meet for one hour every six weeks or so, depending on student schedules. First- and second-year medical students attending the labs are taught very basic core skills, such as how to suture, how to load instruments, how to tie knots using knot-tying practice boards, etc. “Knowledge from these labs goes a long way. When the students do their clerkships and internships, knowing these things and being able to assist in the most basic way will make them look better,” she states. “So that familiarity goes a long way.”

Dr. David Welling, right, offers suturing advice to Navy Ensigns Trevor Elam and Allysa Taylor, both first-year medical students and members of USU’s Surgery Interest Group.  (Image credit: Sharon Holland)

These labs have evolved over the years under the expert guidance and instruction of David R. Welling, MD, FACS, professor of Surgery, and George McNamee, MD, research assistant professor, both with the USU-WRNMMC Department of Surgery. Raffetto teaches all of the labs she plans, and other SIG officers volunteer their time when they can. Sessions often involve using suture boards, learning basic techniques (e.g., simple interrupted and continuous sutures), handling needles, and mastering knot-tying. In practices, a simple suture procedure may involve a 30-second run-through of the following: load needle driver, evert first edge, pierce first side, pass through, reload, pierce second side, pass through, start first knot, spool, finish first knot, tie second knot, tie third knot, and cut. As you can tell, suturing is a lot more complicated than it looks.

In addition, twice per year, SIG students participate in a collaborative skills workshop with the Graduate School of Nursing (GSN) students. Some of the SIG officers and/or members then act as teaching assistants for the GSN students. “So,” reports Raffetto, “we show up for their lab and teach them how to suture, how to tie knots, how to take punch biopsies, how to make incisions, how to handle surgical instruments, etc.” Once the GSN students are finished, then SIG students come in and practice their suturing skills. “It’s awesome,” she says.

The Surgery Interest Group sponsored a surgical skills lab where medical students could perfect their suturing and knot-tying techniques. (Image credit: Sharon Holland)

Because there are not that many opportunities available for first- and second-year medical students to have hands-on learning, the advantages provided by SIG have encouraged the growing proficiency of student surgical and procedural skills. These hands-on skills are ultimately important to every physician. Even primary care physicians need to have basic technical skills for performing procedures (e.g., suturing basic lacerations, draining abscesses, etc.) in-office.

Raffetto, when asked about the benefits of the suture skills lab, acknowledged, “I really think that it’s about familiarity and knowing the things you need to practice. It all rolls into getting the preparation to shine so that when someone does eventually hand you those instruments and says ‘show me what you can do,’ then you can actually do something. And we all want to look good in our clerkships.”