Augmented terminal feedback influences cognitive ability of surgical trainees: a randomised controlled trial

IntroductionFormative assessments in the form of Global assessment (GAS) and procedural based assessment (PBA) are the current methods used for feedback in British laparoscopic surgical training. Video error signature feedback (VESF) has been proposed as an alternative approach to enhance motor skills in laparoscopic training through influencing cognitive approach.MethodsTwenty laparoscopic novice students were randomised into Current standard feedback (CSF) and VESF groups. Both groups tied laparoscopic double square knots in four sequential stages. Standard human reliability assessment method (HRA) was utilised to assess unedited video recordings for errors. A validated scoring system by expert trainers assessed proficiency gain. Similar assessment was performed for both groups. Unedited video recordings of the VESF group were annotated for errors at each stage and provided as feedback through video hosting website. CSF group received assessment sheet as their feedback, comparable to current practice. Error numbers, time execution and proficiency gain were the outcomes. Inter-rater reliability among trainers for error detection was established.ResultsA total of 6490 movements were studied with 1613 errors detected. VESF group committed significantly less errors as compared to the CSF group [1011/1613 (63%) vs 602/1613 (37%), p < 0.01]. VESF group gained proficiency earlier. Time execution was similar. Inter-rater reliability for error detection was high (p = 0.96).DiscussionVESF effects cognitive framework of a laparoscopic task in trainee’s mind, ultimately reducing errors. This work demonstrated the practical application of video error signature feedback by demonstrating a simple laparoscopic task and analysing its learning process through novice brains