USE OF A PAPER-CUT AS AN ADJUNCT TO TEACHING THE WHIPPLE PROCEDURE BYVIDEO

BACKGROUND: Medical students often experience difficulty comprehending anatomic relationships of complex operations to which they ave expose d during surgical clerkship. Pancreaticoduodenectomy, the Whipple proc edure, is one such operation. Although video recordings ave available to facilitate the learning of the Whipple procedure, commercially avai lable tapes ave not self-explanatory to the uninitiated. Since we have previously demonstrated that third-year medical students could learn the operative steps of inguinal herniorraphy by a paper-cutting exerci se, we set out to determine whether an exercise of similar design coul d enhance a student's comprehension of the Whipple procedure. METHODS: Using Adobe Illustrator 5.5 for MacIntosh, an exercise was developed on a 8.5 x 11-inch paper that could be distributed to students for sel f-administration. The exercise was performed using a #15 scalpel or an iris scissors. Thirty-seven students were randomized into two groups. Each student received a pretest of questions focusing on the Whipple procedure. Group I was shown an 18-minute commercially available teach ing video on the Whipple procedure. Group II was given the Whipple ori gami exercise, which required 20 minutes to complete. A first posttest was administered to each group. Next, the groups switched exercises, and a second posttest was administered. RESULTS: There was no signific ant difference between the groups' pretest scores (two-tailed t test, P = 0.290). Group I improved its score from an average of 64.21 (SD 14 .27) to 67.89 (SD 13.16) after watching the video, and further to 77.8 9 (SD 14.37) after completing the paper-cut exercise. Group II improve d from 60.00 (SD 9.43) to 78.95 (SD 11.00) after performing the paperc ut, but derived no additional measurable benefit from watching the vid eo, average score 74.74 (SD 18.37). After the first exercise, students who performed the paper-cut showed a significantly greater improvemen t in test scores compared with students who saw the video (P = 0.0035 by Mann-Whitney U). After both groups had completed the exercises, the mean changes from baseline were no longer significantly different (P = 0.58 by Mann-Whitney U). CONCLUSION: AS a single educational interve ntion, the paper-cut exercise was a more effective teaching device tha n the video in the given time frame. The origami model may be generali zed to a variety of surgical procedures and appears to be a valuable a djunct to traditional teaching. (C) 1998 by Excerpta Medica, Inc.