Knotbox: A Potential Low-cost Knot-tying Simulation Model For Lmic Medical Students Prototyped During K.n.o.t Campaign.

Knotbox: A Potential Low-cost Knot-tying Simulation Model For Lmic Medical Students Prototyped During K.n.o.t Campaign.

Sulav Katuwal , Ashin Nepal, Prapti Lakhey, Ashmita Khatri, Prarthana Subedi, Bikram Thapa, Mahmoud Loubani, Bishow Karki
Chitwan Medical College, Bharatpur, Nepal; Nepal Medical College, Kathmandu, Nepal; KIST Medical College, Kathmandu, Nepal; National Academy of Medical Sciences, Kathmandu, Nepal; Royal Victoria Infirmary, New Castle, United Kingdom; Hull university teaching hospitals ,NHS Trust, Hull, United Kingdom

Introduction: Simulation-based training enhances surgical skills through interactive, risk-free environments. However, low- and middle-income countries (LMICs) face limited access to simulation and practice due to limited resources.

Aim: To assess the usability, effectiveness, and cost-efficiency of the knotbox for practicing surgical knot-tying skills.

Methods: Medical students were trained in knot-tying via simulation using the self-constructed Knot-Box. The model was constructed assembling the cheapest and the most recyclable materials available to LMIC medical students. A thorough training session was held on the model construction and was also guided via pre-recorded visuals. The peers were then asked to demonstrate the surgical knot-tying techniques on the self-constructed model. Henceforth the data from 672 peer-review responses were collected after the K.N.O.T campaign and analyzed for model usage, perceived usefulness and cost-effectiveness.

Results: Students perceived the knotbox as easy to use and effective for enhancing knot-tying skills. Out of 672 participants, 65.3% used the knotbox, 29.9% used a cup, and 4.8% used both. The knotbox was effective for skill practice (3.67 ± 0.59 on a 4-point scale). Participants found it cost-effective (2.86 ± 0.41 on a 3-point scale) and strongly recommended its use (4.72 ± 0.56 on a 5-point scale). Multiple-response evaluation showed that the knotbox was useful for all knot-tying practice (62.8%), improved motor skills (50.1%) and confidence (51.0%), and was noted for ease of use (52.5%), stability (33.2%), and portability (31.5%).

Conclusion: The knotbox proved cost-effective, easy to use, and effective in improving knot-tying skills and confidence, making it ideal for resource limited training(LMICs).

Keywords: Cost effectiveness , strongly recommended