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SIMULATION TRAINING IN GASTROINTESTINAL ENDOSCOPY: WHAT TYPE OF FEEDBACK IS MOST EFFECTIVE?
C Walsh1, S Ling1, C Wang2, H Carnahan3
1Division of Gastroenterology, Hospital for Sick Children; 2Division of Gastroenterology; 3Faculty of Medicine, University of Toronto, Toronto, Ontario
Aims: This study sought to determine the optimal timing of expert feedback (concurrent versus terminal) in promoting skill acquisition and retention in novices learning to perform endoscopy in a simulated setting.
Methods: Thirty novice endoscopists were pre-tested on a bench model endoscopy simulator task which involves navigating a real colonoscope through a series of marked targets as quickly and accurately as possible. Participants were then assigned randomly to receive expert feedback either during (concurrent feedback) or after (terminal feedback) each practice trial. All participants underwent 12 trials of practice in their assigned training condition. The effectiveness of training was assessed using both an immediate post-test and 1 week later using both a retention and transfer test to a novel path through the simulator. Performance measures included time to advance and blinded expert assessment of performance. In addition, novices were asked to rate the quality of the feedback they received and provide suggestions for improvement.
Results: The terminal and concurrent feedback groups performed similarly during the pre-test. Both groups improved significantly after practice (p<0.05). The time to complete the practice session was shorter (33.3min vs. 39.24min) for the concurrent feedback group; however there was a practice advantage in the time to complete the transfer test for the terminal feedback group (p=0.05). Students in both groups rated the feedback as equally useful, clear and timely. However, when asked for suggestions for improvement, a number of students in the terminal feedback group stated that they would have preferred to receive concurrent feedback during each practice trial.
Conclusions: These results show that both terminal and concurrent feedback facilitate endoscopy skill acquisition in novices in a simulated setting. Although terminal feedback resulted in a longer practice session the extra time invested resulted in better learning.