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J Surg Educ. 2017 Jun 29. pii: S1931-7204(17)30123-X. doi: 10.1016/j.jsurg.2017.06.004. [Epub ahead of print]

Self-Directed Interactive Video-Based Instruction Versus Instructor-Led Teaching for Myanmar House Surgeons: A Randomized, Noninferiority Trial.

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Johns Hopkins University School of Medicine, Baltimore, Maryland.
University of Medicine 1, Yangon, Myanmar.
Johns Hopkins Biostatistics Center, Johns Hopkins University of Public Health, Baltimore, Maryland.
Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Surgery, Johns Hopkins University, Baltimore, Maryland. Electronic address:



To compare self-directed interactive video-based instruction (IVBI) with instructor-led teaching in the acquisition of basic surgical skills by House Surgeons at University of Medicine 1, Yangon.


A prospective, 1:1 randomized controlled trial was conducted. Participants were randomized into 2 teaching arms: (1) self-directed IVBI or (2) instructor-led teaching. Self-directed IVBI participants were provided with a portable DVD player that could play, fast forward, rewind, and skip through skills modules. Participants in the instructor-led teaching group were taught in small groups by standardized instructors. Pretesting and posttesting of 1-handed knot tie, 2-handed knot tie, vertical mattress suture, and instrument tie was performed using the Objective Structured Assessment of Technical Skills (OSATS). Students randomized to self-directed IVBI completed an exit survey to assess satisfaction. Demographic data were collected of all participants.


University of Medicine 1, Yangon, Myanmar.


Fifty participants were randomly selected from 78 eligible House Surgeons who were enrolled in their basic surgery rotation.


Demographic characteristics and baseline skills were comparable in participants randomized to IVBI and instructor-led teaching. Mean OSATS score increased from pretest to posttest in both groups (p < 0.001). The mean posttest OSATS score of the IVBI group was 0.72 points below that of the instructor-led teaching group (90% CI: -3.8 to 5.2), with the 90% CI falling below the a priori noninferiority margin, satisfying criteria for noninferiority. More than 90% of students marked either "agree" or "strongly agree" to the following statements on the exit survey: further expansion of IVBI into other skills modules and integration of IVBI into training curriculum.


IVBI is noninferior to instructor-led teaching of surgical skills based on OSATS scores. House Surgeons highly rated self-directed IVBI. Self-directed IVBI has the potential to significantly reduce the personnel required for skills teaching and may serve as a long-term learning adjunct in low-resource settings.


Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; global surgery; knot tying; medical education; self-directed interactive video-based instruction; suturing

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