I know you could just as easily search for surgical knot tying tutorials yourself, I just wanted to provide you with a list of references for it. Tying knots is the sort of thing that can be a huge stress if you're not as up-to-speed as some of your colleagues. Now, I'm not telling you to worry night and day if you are not as proficient as you think you should be... instead, I'm telling you that you do need to practice. There's no question about that.

Actually, it's kind of interesting... in Malcolm Gladwell's book, Outliers, he explores several success stories - the likes of Bill Gates, the Beatles, etc. Gladwell charts the course of the successful. And you might be shocked at some of his findings... like the fact that birth month has a huge impact on success in Canadian hockey leagues. It makes sense. These young boys that are born after the cut off date for starting end up starting the league a little older (albeit only 11 months). They have had time to refine their skills, mature a tad more, etc.

Upon entering the league a slight cut above the other players, they are then shunted into better instruction, all-star teams, and more positive attention. Better coaching and playing against better players means getting better and better. The cycle continues.

In a way, this is not unlike internship and residency training. If you enter your internship (perceived to be) ahead of the others, the attendings begin to talk about you in a favorable way... they give you more responsibility... they pay a little more attention to you... they expect a little more out of you... and you respond in a way that is expected... You get better and better.

Why did I just blab on about all of that? Well, I am Wordy Boy and I want to tell you to practice. Practice, practice, practice. Tying knots will be mundane by the time your training is over, but in the beginning it can be pretty stressful... especially when anesthesia is huffing and puffing, the OR nurses are tapping their feet, and the surgeon just started rounds without you. Trust me on this.

Before reading or watching any of the resources below, give a call to Ethicon. Call 1-800-255-2500 and they'll ship the necessary stuff to you for free. Their site doesn't mention it any more, so I'm not sure if they stopped offering them. But just in case, here's what you should ask for:

• Ethicon Knot Tying Board
• Ethicon Knot Tying Manual
• Ethicon Knot Tying Rope

By the way... when you're done going through these, watch the last video to see how you can get my number one secret to an outstanding 4th year of medical school and a wildly successful internship. It's kind of cool, kind of not, because I was burning out and ready to quit. When I got this advice, everything not only got better... I skyrocketed to be the most celebrated resident in the program.

Handouts and E-Books:

• Suturing Basics - in-depth site on suture basics. Pretty awesome site maintained by Boston University. It may be a little more than you need, but it is probably the best place to start on this page.
• More knot-tying manuals to come...

Audio Downloads:

• Coming Soon - if I can find anything useful.

Videos:

Here's one that demonstrates an instrument tie:

Here's a one-hand tie:

Other Links:

• Cine-Med - Suture and Tying Kit with DVD - completely outrageous pricing... don't get it. But if you look at this page, you can see all of the things you need to begin suturing and knot-tying practice.
• Suturing Tutorial - although this a PowerPoint type presentation, it has some great slides in the middle of it. They go through the steps you take and why. Simple things like repositioning are even covered.
• Have Some Suture Fun with Photoshop - this might be a little corny, but just in case you want to spoof up some photos... You can learn how to make surgical scars and sutures with PhotoShop in this tutorial.

The Number One Strategy for 4th Year of Med School and Internship: