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Optimising surgical training: use of feedback to reduce errors during a simulated surgical procedure
  1. Emily Boyle1,
  2. Musallam Al-Akash1,
  3. Anthony G Gallagher1,2,
  4. Oscar Traynor1,
  5. Arnold D K Hill1,
  6. Paul C Neary1
  1. 1National Surgical Training Centre, The Colles Institute, Royal College of Surgeons in Ireland, Dublin 2, Ireland
  2. 2Department of Psychology, Queen's University, Belfast, Ireland
  1. Correspondence to Department of Psychology, Emily Boyle, Colles Institute, Royal College of Surgeons in Ireland, 121 St Stephen's Green, Dublin 2, Ireland; emboyle{at}


Objective To assess the effect of proximate or immediate feedback during an intensive training session. The authors hypothesised that provision of feedback during a training session would improve performance and learning curves.

Methods Twenty-eight trainee surgeons participated in the study between September and December 2008. They were consecutively assigned to group 1 (n=16, no feedback) or group 2 (n=12, feedback) All the participants performed five hand-assisted laparoscopic colectomy procedures on the ProMIS surgical simulator. Efficiency of instrument use (instrument path length and smoothness) and predefined intraoperative error scores were assessed. Facilitators assisted their performance and answered questions when asked. Group 1 participants were given no extra assistance, but group 2 participants received standardised feedback and the chance to review errors after every procedure. Data were analysed using SPSS V.15. Mann–Whitney U tests were used to compare mean performance results, and analysis of variance was used to calculate within-subject improvement.

Results Group 1 achieved better results for instrument path length (23 874 mm vs 39 086 mm, p=0.001) and instrument smoothness (2015 vs 2567, p=0.045) However, group 2 (feedback) performed significantly better with regard to error scores (14 vs 4.42, p=0.000). In addition, they demonstrated a smoother learning curve. Inter-rater reliability for the error scores was 0.97.

Conclusion The provision of standardised proximate feedback was associated with significantly fewer errors and an improved learning curve. Reducing errors in the skills lab environment should lead to safer clinical performance. This may help to make training more efficient and improve patient safety.

  • Training
  • virtual reality
  • augmented reality simulator
  • hand-assisted laparoscopic colectomy
  • feedback
  • metrics
  • education and training (see medical education and training)
  • minimally invasive surgery
  • medical education and training
  • colorectal surgery

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  • Funding Ethicon Endosurgery Inc, 4545 Creek Road, Blue Ash, OH 45242, USA.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the RCSI research and ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.