Cross-Suturing is Effective for Teaching Suturing Skills: A Randomized, Controlled Trial

Sophie L. Cemaj, Thomas W. Connely, Heidi H. Hon, Kelsey R. Tieken, Sean C. Figy, Shannon L. Wong, Abbey L. Fingeret

Research output: Contribution to journalArticlepeer-review


Introduction: Basic suturing is a skill expected from graduating medical students. A proposed concept to increase suturing competency is to integrate art by mixing cross-stitching with suturing. We hypothesize that students trained with “cross-suturing” would improve suturing performance. Methods: We performed a randomized controlled trial of preclinical medical students using an art-based cross-stitching method intervention compared with conventional suturing. Both groups were provided with an introductory suturing video. Assessment of simple interrupted suturing were conducted preintervention and postintervention, and at 2-wk follow-up with a video review by blinded expert raters using the American College of Surgeons basic suturing and knot tying performance rating tool. Students completed a self-assessment of proficiency, confidence, and anxiety. Statistical analysis was performed using unpaired t-tests. Results: A total of 16 preclinical medical students participated. Self-assessment and objective suturing performance were comparable in the preintervention measurements. The intervention group showed significant improvement compared to the control group with median (interquartile range) self-assessment scores 9 (8.5-9) compared with 6.5 (6-7.5) (P < 0.01) and objective performance scores of 25.25 (22.75-27) compared with 16.5 (14.5-18.5) (P < 0.01). The intervention group showed retained skills at the 2-wk follow up with no differences in self-assessment or objective suturing scores immediately postintervention compared with two-wk follow-up with self-assessment scores of 9 (8.5-9) versus 9 (8-9) at 2 wk (P = 0.16) and objective performance score of 25.25 (22.75-27) versus 24.75 (23.5-26.5) at 2 wk (P = 0.29). Conclusions: The cross-suturing intervention improved suturing skills in this cohort. This low-cost approach to medical student surgical education should be explored on a larger scale.

Original languageEnglish (US)
Pages (from-to)228-237
Number of pages10
JournalJournal of Surgical Research
StatePublished - Jan 2023


  • Art
  • Cross-stitching
  • Education
  • Suturing

ASJC Scopus subject areas

  • Surgery


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