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Instructor Feedback Versus No Instructor Feedback on Performance in a Laparoscopic Virtual Reality Simulator: A Randomized Trial

Strandbygaard, Jeanett PhD*; Bjerrum, Flemming MD*; Maagaard, Mathilde MD*; Winkel, Per DMSc; Larsen, Christian Rifbjerg PhD; Ringsted, Charlotte PhD§; Gluud, Christian DMSc; Grantcharov, Teodor PhD; Ottesen, Bent DMSc; Sorensen, Jette Led MD*

doi: 10.1097/SLA.0b013e31827eee6e
Randomized Controlled TrialS

Objective: To investigate the impact of instructor feedback versus no instructor feedback when training a complex operational task on a laparoscopic virtual reality simulator.

Background: Simulators are now widely accepted as a training tool, but there is insufficient knowledge about how much feedback is necessary, which is useful for sustainable implementation.

Methods: A randomized trial complying with CONSORT Statement. All participants had to reach a predefined proficiency level for a complex operational task on a virtual reality simulator. The intervention group received standardized instructor feedback a maximum of 3 times. The control group did not receive instructor feedback. Participants were senior medical students without prior laparoscopic experience (n = 99). Outcome measures were time, repetitions, and performance score to reach a predefined proficiency level. Furthermore, influence of sex and perception of own surgical skills were examined.

Results: Time (in minutes) and repetitions were reduced in the intervention group (162 vs 342 minutes; P < 0.005) and (29 vs 65 repetitions; P < 0.005). The control group achieved a higher performance score than the intervention group (57% vs 49%; P = 0.004). Men used less time (in minutes) than women (P = 0.037), but no sex difference was observed for repetitions (P = 0.20). Participants in the intervention group had higher self-perception regarding surgical skills after the trial (P = 0.011).

Conclusions: Instructor feedback increases the efficiency when training a complex operational task on a virtual reality simulator; time and repetitions used to achieve a predefined proficiency level were significantly reduced in the group that received instructor feedback compared with the control group. Trial registration number: NCT01497782.

In a randomized trial, we investigated the impact of standardized instructor feedback versus no instructor feedback when training a complex operational task on a laparoscopic virtual reality simulator. We found that the intervention group, which received feedback, was twice as efficient regarding time and repetitions compared with the control group.

*Department of OBGYN, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark

Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

Department of OBGYN, Hillerød Hospital, Hillerød, Denmark

§Centre of Clinical Education, University of Copenhagen, Copenhagen and Capital Region, Copenhagen, Denmark

Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada

Juliane Marie Centre, Centre for Children, Women and Reproduction, Copenhagen, Denmark.

Reprints: Jeanett Strandbygaard, PhD, Department of OBGYN, 4074, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark. E-mail:

Disclosure: The Copenhagen University Hospital Rigshospitalet and TrygFonden, a nonprofit organization, supported the project. The contents of the manuscript are solely the responsibility of the authors and do not necessarily represent the official views of Rigshospitalet or TrygFonden. The authors declare no conflicts of interest.

The trial complies with the Helsinki Declaration on biomedical research. The Danish National Committee on Biomedical Research Ethics evaluated and approved the trial (journal number: H-3-2010-082). The Danish Data Protection Agency approved collection, analysis, and storage of data (approval code: 2007-58-0015/30-0996).

All participants were provided written information on the trial. Participation was voluntary; no material goods were given to participants. The trial is registered at with trial registration number: NCT01497782.

© 2013 by Lippincott Williams & Wilkins.