**Abstract**

There have been reduced opportunities for surgical skill acquisition due to the COVID-19 pandemic and the regulated training hours. Despite these challenges, self-regulated learning allows trainees to learn continuously, and motor skills development can be augmented through mental practice and motor imagery. The aim of this chapter is to introduce the theoretical concepts in skill acquisition and the role of mental and deliberate practice as an alternative for skill training. A case study is presented using a design and development framework for producing an online basic micro suturing training resource based on self-regulated learning. This case study demonstrates the use of the ADDIE instructional design model and Mayer's multimedia theory guidelines, for creating online instructional resources. The methodological approach of a design and developmental framework to create an educationally sound online training module for micro suturing which has significant utility in hand surgery is discussed in this chapter. The tools described in this chapter are translatable to any psychomotor skills development in medical education.

**Keywords:** micro suturing, mental script, mental practice, motor imagery, deliberate practice

### **1. Introduction**

The transformative changes occurring in the technology, political and economic landscape has not spared medical education (ME), which is further compounded by the ever-increasing knowledge and skills in medicine. The last few decades have seen an increasing expectation in the efficient utilisation of resources in ME. Despite all these changes and investments, doctors who are fit to practice competently in the community remain a challenge – lacking in the soft skills of medical practice and the hard skills of knowledge and procedural skills. It has been documented that ME has failed to meet the community's needs altogether [1]. There is a call by all transdisciplinary stakeholders for value for money, universal access, and increased quality of care, and this has impacted the medical education field, including suggestions to adopt a transdisciplinary and transnational approach to designing and delivering competency-based medical education. This requires an alignment and integration of medical education to quality of care to patients and populations with a sense of accountability founded on social justice [2].

Surgery as a specialty is dependent on psychomotor skills and has traditionally followed a mentor-apprenticeship model where experienced surgeons train the learners in the work environment [3] to produce surgeons who are competent in specific motor skills within a stipulated time. Learners need to aspire to excellence in the interest of their patients [4]. The traditional surgical training models, including mentoring, role-modelling, and one-to-one supervision, produce skilled and competent surgeons. However, this mode of teaching is vanishing due to time constraints and the heavy burden of service commitment to meet the needs of the community [5, 6]. The emphasis on service efficiency has curtailed on-thejob teaching and exposure to live patients in the current hospital environments. Innovative strategies have been adopted to make the programmes more flexible and efficient, more trainee-oriented, incorporating innovations like simulation technology, competency-based assessments, online learning, and resources, emphasizing teamwork, professionalism, communications, and quality patient care [7]. The aim of a surgical training is to produce competent surgeons skilled and safe, who fulfill the community's needs [8–11].
