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. Standard procedural skills training methods include a tutorial, workshop, and feedback. Written manuals might add value to those standard methods; nevertheless, it depends on how well they are composed. This research aimed to evaluate the efficiency of well-written manuals of hand-knotting skills to improve students' procedural skills learning and competency. Method. This research was conducted through a preliminary study to identify the assessor reliability and main study to evaluate the students' scores for reef and surgeon's knots using an objective structured assessment of technical skills (OSATS). Subjects' preparedness and perception of the quality of the manuals were evaluated through a survey. Students were randomly divided into two groups. The treatment group received written manuals a day before the workshop. Both groups experienced the same five steps procedural skills teaching methods. The results were analyzed by SPSS 17.0 through the Pearson Chi-square test and independent t-test. Results. A preliminary study showed that the assessors had no difference in evaluating students' skills. The main study included 31 subjects in the treatment group and 34 subjects in the control group. The OSATS scores were statistically significantly different between the groups. Students in the treatment group had higher mean scores (43.42±7.98) than those in the control group (27.21±5.64); p<0.05. None of the control group students felt prepared, and most students (77%) considered the manuals to be well written. Conclusion: Well-written manuals of hand-knotting skills given before skills training improve students' skills acquisition and the standard teaching methods.

The Efficiency of Well-Written Manuals Aided-Hand Knotting Skills Acquisition for Undergraduates