Identifying Motivational Factors That Increase Suturing Practice in Emergency Medicine Clerkship Students

Suturing is a basic procedural skill needed during emergency medicine (EM) clerkships. This study evaluated if intrinsic motivation to gain suturing proficiency, as measured by the Intrinsic Motivation Inventory (IMI), influenced fourth-year (M4) EM clerkship student engagement with an asynchronous suturing refresher with a take-home suture kit. We hypothesize that identifiable factors, such as IMI domains or specialty choice, increase EM M4 use of the take-home suture kit.

This prospective observational study was deployed through a single academic institution’s EM clerkship from March to October 2025. 121 EM M4s were provided a take-home suture kit for two weeks, then surveyed on kit use, planned specialty, and motivation to acquire suturing proficiency across seven IMI domains: Effort/Importance, Value/Usefulness, Perceived Choice, Perceived Competence, Relatedness, Pressure/Tension, and Interest/Enjoyment. Associations between kit use and intended specialty were tested with one-sided Fisher’s exact tests, hypothesizing higher odds of use in EM- and surgery-bound students. Welch’s two-sample t-tests assessed one-sided hypotheses of higher mean IMI domain scores among kit users.

121 survey responses were received. 3 were incomplete, leaving 118 analyzed. 54 students used the kit at least once. Students pursuing EM had significantly increased odds of kit usage (OR = 6.469, 95%CI 1.137-∞). Students pursuing surgical specialties had increased odds of usage, but this was not significant (OR = 1.215, 95%CI 0.490-∞, Power = 57.0% to detect OR = 2.5). A test comparing students pursuing either EM or a surgical specialty versus all others suggested increased odds of usage in the combined group, but this was not significant (OR = 1.974, 95%CI 0.890-∞ Power = 59.4% to detect OR = 2.5). Kit users had significantly higher scores in the Effort/Importance (95%CI 1.33-∞), Value/Usefulness (95%CI 0.69-∞), and Interest/Enjoyment IMI domains (95%CI 0.55-∞).

M4s who found suturing important, useful, and enjoyable were more likely to use the kit. This aligns with research suggesting that trainees better engage with educational interventions they perceive as relevant to future practice. Limitations include the single-center design and short lending period. These findings may inform future design of asynchronous educational interventions.