PURPOSE: The purpose of this study was to evaluate the effectiveness of teaching residents how to repair a tendon using a simulation model.

METHOD: Ten surgical residents with no prior experience repairing tendons were shown how to perform a 4-strand cruciate flexor tendon. The residents then performed ten repairs each on the simulated tendon while being timed and graded by a hand surgeon using a global rating scale. The simulated model consisted of a white, round synthetic bait worm 10 mm in diameter. Six residents also performed a zone IV flexor tendon repair on a fresh frozen cadaver - three residents chosen at random from the ten who had practiced and three other residents who had no practice on the simulated tendon.

RESULTS: The mean initial quality score was 2.4/5.0 which improved to 4.8/5.0 by the 10th trial. There was a significant incremental improvement in mean performance from trial 1 to 10 (p < 0.0001) without clear evidence of leveling off before trial 9 (mean performance 4.6/5.0). The mean time to complete the first repair was 5.4 minutes; this decreased to 3.0 minutes by the last repair. In the cadaver trial, there was statistically significant evidence (p = 0.05, one-sided Wilcoxon exact test) that the three residents previously trained with the simulated tendon had a higher median performance (4.4, min=4.3, max=4.8) than the three who had not been trained (1.8, min=1.7, max=2.1). The mean time to complete the repairs was 4.0 and 5.8 minutes, respectively.

CONCLUSION: This inexpensive model mimics an in vivo tendon repair experience with sufficient fidelity to justify its use in training residents to perform a tendon repair. Ten simulated repairs per resident is sufficient. These residents have subsequently reported good confidence and minimal anxiety in performing their first true operative flexor tendon repair.