Augmented Terminal Feedback Influences Cognitive Ability of Surgical Trainees: A Randomized Controlled Trial

M. K. Riaz, M. Tang, H. O. R. Phing, B. Tang, A. Alijani

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Introduction: Formative 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 inlaparoscopic training through influencing cognitive approach.

Methods: Twenty laparoscopic novice students were randomized 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 utilized 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.

Results: A 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).

Discussion: VESF 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 analyzing its learning process through novice brains.
Original languageEnglish
Pages (from-to)1-7
Number of pages7
JournalInternational Journal of Surgery and Clinical Practice
Issue number1
Publication statusPublished - 29 Mar 2021


  • Human reliability assessment
  • Video error signature feedback
  • Augmented terminal feedback
  • Mental cognitive framework
  • Error assessment sheet


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