Outcomes of a Newly Developed Step-by-Step Progressive Course for Basic Microsurgical Suturing Skills in a Resource-Limited Setting: A Quasi-Experimental Study from Jordan

Background: Microsurgical education often requires resource-intensive training, limiting access in low-resource environments. We developed and evaluated a low-cost, stepwise microsurgical suturing curriculum designed to improve dexterity, depth perception, and instrument handling. Methods: Twenty-four participants were recruited online and assigned to small-group sessions (three per session). The 3–4 hour course comprised seven progressive exercises: (1) alternating dot-touching with Castroviejo needle holder and forceps, improving fine movement; (2) needle insertion through clock-positioned holes on a 3D-printed bridge under loupes; (3) repeating #2 using a smartphone-based microscopy; (4) simple interrupted balloon sutures under loupes; (5) repeating #4 with smartphone microscopy; (6) 0. 7–2 mm synthetic vessel anastomosis on a pocket suture® card with 10-0 nylon under loupes; (7) repeating #6 with smartphone microscopy. Pre/post performance was video-recorded and independently scored using OSATS tool. Participants completed self-assessments. Shapiro–Wilk tested normality. Paired t-tests, Pearson correlations, Wilcoxon signed-rank, and Spearman correlations assessed differences and associations. Multivariable regression tested predictors (presession scores, gender, academic level, handedness, prior experience, and exercise completion). The study was preregistered on OSF (DOI: 10. 17605/OSF. IO/FDNC2). Results: Twenty-four participants (13 males, 11 females; mean age 22. 3 y) were included, mostly medical students (n=15), with 3 residents and 2 interns; 8 had prior microsuturing experience. Adherence was high: 12 completed all seven exercises, 4 completed six, and 8 completed five. Three were left-handed. Normality was confirmed (all p>0. 12). OSATS scores increased from 14. 7 (SD 5. 84) to 26. 3 (SD 4. 97), mean gain 11. 6 (95% CI 9. 3–13. 9), t (22) =10. 35, p<0. 001, with very large effect sizes (Cohen’s d=2. 16; Hedges’ g=2. 08). Wilcoxon confirmed robustness (z=4. 2, p<0. 001). The greatest gains were in instrument knowledge, while time and motion remained relatively lower. Self-assessments (mean 27. 6) did not correlate with postsession scores (Pearson r=0. 20, p=0. 367; Spearman ρ=0. 18, p=0. 428), but exercise completion correlated strongly (Pearson r=0. 57, p=0. 004; Spearman ρ=0. 58, p=0. 004). The primary regression model (presession scores, gender, academic level) explained 38. 9% of variance (F (3, 17) =3. 61, p=0. 035, adj. R²=0. 28), with academic level significant (β=4. 36, p=0. 044). Exploratory models improved fit with handedness (adj. R²=0. 44, p=0. 009), identifying both academic level (β=5. 13, p=0. 011) and handedness (β=4. 99, p=0. 028) as predictors. Conclusion: This progressive model supports affordable microsurgical training in low-resource contexts. It produced robust performance gains. Results were consistent across parametric and nonparametric analyses. Academic level and exercise completion predicted success, while self-assessments did not.