Journal of Surgical Simulation 2018; 5: 99 - 104

Published: 15 January 2019


Original article

Will SCOBY do? An alternative for teaching basic surgical skills of suturing and skin excision

Amber van Dreven, Sue J. Garner, Sean T. MacDermott, Mark W. Yates and Steve G. Costa
Corresponding author: Amber van Dreven, Faculty of Health, School of Medicine, Deakin University, Geelong, Victoria, Australia. Email:


Background: Using pork or ethylene-vinyl acetate (EVA) pads to teach suturing and excision skills to medical students can be expensive and lack a degree of realism. This project aimed to ascertain if a symbiotic culture of bacteria and yeast (SCOBY) represented a viable alternative.

Methods: Part 1 of this study was designed to identify the descriptors against which SCOBY, pork and EVA pads could be evaluated. Participants in part 1 were asked to identify elements of fidelity that best represented skin when comparing the three models. Part 2 of the study required a second cohort of participants to rank the three models against the descriptors identified.

Results: The overall results indicate that, with the exception of odour, respondents rated SCOBY superior to EVA pads and equivalent to pork. There were no significant differences between pork and SCOBY for skin likeness, cutting likeness, and suturing likeness, although both were deemed superior to EVA pads. Qualitative feedback indicated that SCOBY was not as robust as pork and lacked the layers of skin that pork better represents. Cultural and religious impediments to using pork models were also highlighted.

Conclusion: SCOBY offers a viable, low-cost alternative to pork to teach suturing and excision with comparable fidelity to pork and a superior fidelity to EVA pads. The smell of SCOBY is mildly vinegary due to the secondary fermentation of alcohol to acetic acid. Ten percent of the participants in part 2 of the study identified cultural or religious barriers to using pork.


medical education; suturing; cultural sensitivity; cost effectiveness; simulation; skin model