A step-by-step training system for endoscopic suturing and ligation incorporating flipped learning into e-learning: the Gunma step-by-step training e-learning procedure (G-STEP).

PURPOSE: To evaluate our step-by-step e-learning program incorporating flipped learning, to help inexperienced surgeons acquire laparoscopic suturing and ligation skills. METHODS: Fourteen postgraduate year 3 (PGY3) surgeons utilized “G-SURGEON,” Gunma University’s e-learning system, to train in three steps: using short needle holders under direct vision, using long endoscopic needle holders under direct vision, and using long endoscopic needle holders while viewing endoscopic images. Test videos were recorded before and after a 1-month training period for each step, and then evaluated using a modified Global Rating Scale. Trainee satisfaction was assessed through a questionnaire. RESULTS: Thirteen trainees completed the program and the pass rates for each step improved after training. The pass rate for STEP 3 (using the same tools as in STEP 2, through training by watching a video) increased from 30.8% to 69.2%. The test time decreased significantly for STEP 2 (using a long endoscopic needle holder under direct vision) (p < 0.01) and STEP 3 (p = 0.04) after training. Moreover, 84.6% of trainees expressed high satisfaction with the program and would recommend it. CONCLUSION: The incorporation of flipped learning into a step-by-step e-learning curriculum may help trainees acquire laparoscopic suturing and ligation skills, enabling them to learn at their own pace, regardless of time or location, and making it a work-in-life conscious training approach.