**5. Evaluation of the online module to teach micro suturing skills**

To evaluate the online module, this case study used the design process in **Table 2**. It includes the evaluation on (1) the effectiveness of the module against the existing training programmes, (2) ease of use for this module, (3) the usability.

This pilot study evaluated the new training module by comparing it with reading the manual and observing the experts performing the surgery. Participants were volunteer medical students via opportunistic sampling from two medical schools in Singapore. All participants had completed an introductory suturing course and had not performed micro suturing procedures before the study. None had prior exposure to mental practice strategies in any domains. The exclusion criteria included non-consent, failure to understand and comply with new training techniques, and


*MIMP (Motor Imagery and Mental Practice); SUS (System Usability Scale); NASA-TLX (NASA Task Load Index); MIQ (Mental Imagery Questionnaire); SMaRT (Stanford Microsurgery and Resident Training Scale Instrument).*

**Table 2.** *Research design matrix.*

failure to meet the inclusion criteria. A sample size of 11 was chosen based on previous studies and available resources for this study.

As seen in **Table 3** below, five experienced hand surgeons (more than five years in practice as consultants/specialists) were recruited via purposeful sampling as an expert for the review process. The panel was also involved in creating the mental script and developing the training module.

#### **5.1 Analysis of key tasks**

A quantitative analysis of the commonly performed procedures was conducted from a previous study [40]. The expert panel used this to determine the index procedure (micro suturing) for this research and the motor skills with various tasks


**Table 3.** *Expert review panel demographics.*

#### *Redefining Surgical Skill Acquisition DOI: http://dx.doi.org/10.5772/intechopen.99408*

and subtasks required to perform micro suturing [40]. For this study, the procedure of nerve grafts and repair was chosen by the expert panel as the index procedure. The basic operative motor skill required to perform this nerve repair surgery is performing micro suturing using the microscope with an 8/0 needle with a diameter of 150 microns (0.15 mm). Mental script development was done as per **Figure 4** of the conceptual framework.
