Effects of Real Time Feedback on Novice's Laparoscopic Learning Curve

Abstract

Objective: Analyze the learning curve of medical students when they are trained with a laparoscopic box trainer and are presented with different modes of real-time feedback on their performance in the laparoscopic suturing procedure.

Design: A prospective randomized controlled trial (RTC) was performed. Three groups were proposed: control, visual, and haptic. The block randomization technique was used to assign the participants to one of the three groups. Each group trained the intracorporeal square flat knot task in a standardized FLS box simulator. A total of 11 sessions were programmed for this study: a pre-training session, eight training sessions, a post-training session, and a follow-up session. Measurement of the generated reaction force during the task were taken weekly for the first 10 sessions (pre-training, training, and post-training); then, the follow-up measurement was taken a month after.

Setting: This study was carried out in a single center at the Unidad de Simulación de Posgrado (USIP) of the postgraduate medicine program of the Universidad Nacional Autónoma de México (UNAM) between May and August 2023.

Participants: The eligible participants were medical students without experience in minimally invasive surgery. All social service intern medics doing their social service in the USIP were invited to participate. A total of 20 participants entered the study from which 18 of them finished all the programmed sessions.

Results: A total of ten metrics were extracted from the reaction force signal measured at each session. All metrics are directly proportional to the reaction force and low magnitudes imply high tissue-handling proficiency. All groups improved their tissue handling skills, being the visual group the one who achieved better performance, followed by the haptic group and lastly the control group.

Conclusion: The use of real time feedback, especially visual feedback can help novices to shorten the learning process of tissue handling and achieve a better proficiency in advanced tasks in shorter training periods.

Keywords: feedback; laparoscopy; learning; performance; simulation; training.