Speed versus damage: using selective feedback to modulate laparoscopic simulator performance

Abstract

Background: Adaptive training is an approach in which training variables change with the needs and traits of individual trainees. It has potential to mitigate the effect of personality traits such as impulsiveness on surgical performance. Selective performance feedback is one way to implement adaptive training. This paper investigates whether selective feedback can direct performance of trainees of either high- or low impulsiveness.

Methods: A total of 83 inexperienced medical students of known impulsiveness performed a four-session laparoscopic training course on a Virtual Reality Simulator. They performed two identical series of tasks every session. During one series of tasks they received performance feedback on duration and during the other series they received feedback on damage. Performance parameters (duration and damage) were compared between the two series of tasks to assess whether selective performance feedback can be used to steer emphasis in performance. To assess the effectiveness of selective feedback for people of high- or low impulsiveness, the difference in performance between the two series for both duration and damage was also assessed.

Results: Participants were faster when given performance feedback for speed for all exercises in all sessions (average z-value = - 4.14, all p values < .05). Also, they performed better on damage control when given performance feedback for damage in all tasks and during all sessions except for one (average z-value = - 4.19, all but one p value < .05). Impulsiveness did not impact the effectiveness of selective feedback.

Conclusion: Selective feedback on either duration or damage can be used to improve performance for the variable that the trainee receives feedback on. Trainee impulsiveness did not modulate this effect. Selective feedback can be used to steer training focus in adaptive training systems and can mitigate the negative effects of impulsiveness on damage control.

Keywords: Adaptive training; Laparoscopy; Personality; Simulation; Skills development.

Fig. 1

Flowchart for a single training session. Participants always rotated between the stations in the same order and performed at each station once in each session. The total course consisted of four of these training sessions

Fig. 2

Performance comparison for the speed and damage series, for each session and task. Damage series performance is dark gray, speed series performance is medium gray. The black horizontal stripes indicate median values, the boxes indicate quartiles. All damage series and speeds series pairs are different, with the exception of damage in the first ‘Lifting & Grasping’ session

Fig. 3

Performance differences between the damage and speed feedback series, compared for students of high and low impulsiveness. Low impulsiveness shown as dark gray, high impulsiveness as medium gray. Black horizontal stripes indicate median values, the boxes indicate quartiles. Feedback for damage and for speed induced the same performance differences for students of low- and high impulsiveness in all sessions of all tasks (and thus was equally effective for both groups)