How much feedback is necessary for learning to suture? Instructor Feedback Versus No Instructor Feedback on Performance in a Laparoscopic Virtual Reality Simulator: A Randomized Trial Video Coaching as an Efficient Teaching Method for Surgical Residents-A Randomized Controlled Trial. Preoperative Practice Paired With Instructor Feedback May Not Improve Obstetrics-Gynecology Residents' Operative Performance. A Randomized Controlled Trial to Compare e-Feedback Versus "Standard" Face-to-Face Verbal Feedback to Improve the Acquisition of Procedural Skill. Comprehensive Surgical Coaching Enhances Surgical Skill in the Operating Room: A Randomized Controlled Trial. The Implementation of Elaborative Feedback for Qualitative Improvement of Shade Matching-A Randomized Study. An investigation of medical student reactions to feedback: a randomised controlled trial. Teaching suturing and knot-tying skills to medical students: a randomized controlled study comparing computer-based video instruction and (concurrent and summary) expert feedback. Is the use of videotape recording superior to verbal feedback alone in the teaching of clinical skills? Effect of multisource feedback on resident communication skills and professionalism: a randomized controlled trial. The importance of expert feedback during endovascular simulator training. Individualized feedback during simulated laparoscopic training: a mixed methods study Evaluation of a method for improving the teaching performance of attending physicians. Pre-training evaluation and feedback improve medical students’ skills in basic life support Short structured feedback training is equivalent to a mechanical feedback device in two-rescuer BLS: a randomised simulation study Feedback on Oral Presentations During Pediatric Clerkships: A Randomized Controlled Trial The benefit of repetitive skills training and frequency of expert feedback in the early acquisition of procedural skills Feedback providers’ credibility impacts students’ satisfaction with feedback and delayed performance The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. Engaging medical students in the feedback process. Task- versus ego-oriented feedback delivered as numbers or comments during intubation training. Framing of feedback impacts student’s satisfaction, self-efficacy and performance Use of the learning conversation improves instructor confidence in life support training: An open randomised controlled cross-over trial comparing teaching feedback mechanisms. Effectiveness of repeated video feedback in the acquisition of a surgical technical skill. Optimizing the Timing of Expert Feedback During Simulation-Based Spaced Practice of Endourologic Skills
Background Many laparoscopic simulation training systems exist and have been shown to transfer learning of surgical skills to the operating room . The manner in which the training is structured to maximize learning has not been examined . There are many aspects to the acquisition of laparoscopic skills during training , one of which is the availability of knowledge of results ( KR ) . Knowledge of results is information about the outcome of motor skill execution , usually provided to individuals at the end of the execution . The timing and nature of KR can affect how well people learn new motor skills . In addition , detailed instruction during learning can also affect skill acquisition . We studied the effects of KR and instruction on the learning curve of a suturing and knot-tying task . We hypothesized that KR was necessary for skill acquisition , and that detailed instruction would help trainees to learn to perform the task more correctly and reach a performance plateau earlier . In addition , the overall workload of a trainee during training would decrease as skills improved , especially when KR and coaching were provided . Methods Nine medical students with no previous laparoscopic surgical experience were r and omly and evenly divided into three groups with different KR conditions : ( 1 ) no KR , ( 2 ) KR , ( 3 ) KR + instruction . Each subject attended a training session for 1 h each day , 6 days a week for 4 consecutive weeks . Performance measures such as task time , smoothness of instrument , and path length were recorded for each trial . Workload was assessed using the NASA-TLX question naire . Results While KR was necessary for learning to suture , continual instruction had limited additional benefits . However , KR + instruction did reduce subjects ’ perceived overall workload . Conclusions Surgical training could be carried out effectively with only knowledge of results . These results have implication s for the staffing of surgical skills laboratories 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 r and omized 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 st and ardized 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 BACKGROUND As surgical training is evolving and operative exposure is decreasing , new , effective , and experiential learning methods are needed to ensure surgical competency and patient safety . Video coaching is an emerging concept in surgery that needs further investigation . DESIGN In this r and omized controlled trial conducted at a single teaching hospital , participating residents were filmed performing a  side-to-side intestinal anastomosis  on cadaveric dog bowel for baseline assessment . The Surgical Video Coaching ( SVC ) group then participated in a one-on-one video playback coaching and debriefing session with a surgeon , during which constructive feedback was given . The control group went on with their normal clinical duties without coaching or debriefing . All participants were filmed making a second intestinal anastomosis . This was compared to their first anastomosis using a 7-category-vali date d technical skill global rating scale , the Objective Structured Assessment of Technical Skills . A single independent surgeon who did not participate in coaching or debriefing to the SVC group review ed all videos . A satisfaction survey was then sent to the residents in the coaching group . SETTING Department of Surgery , HôpitalMaisonneuve-Rosemont , tertiary teaching hospital affiliated to the University of Montreal , Canada . PARTICIPANTS General surgery residents from University of Montreal were recruited to take part in this trial . A total of 28 residents were r and omized and completed the study . RESULTS After intervention , the SVC group ( n = 14 ) significantly increased their Objective Structured Assessment of Technical Skills score ( mean of differences 3.36 , [ 1.09 - 5.63 ] , p = 0.007 ) when compared to the control group ( n = 14 ) ( mean of differences 0.29 , p = 0.759 ) . All residents agreed or strongly agreed that video coaching was a time-efficient teaching method . CONCLUSIONS Video coaching is an effective and efficient teaching intervention to improve surgical residents ' technical skills BACKGROUND There is evidence that preoperative practice prior to surgery can improve trainee performance , but the optimal approach has not been studied . OBJECTIVE We sought to determine if preoperative practice by surgical trainees paired with instructor feedback improved surgical technique , compared to preoperative practice or feedback alone . METHODS We conducted a r and omized controlled trial of obstetrics-gynecology trainees , stratified on a simulator-assessed surgical skill . Participants were r and omized to preoperative practice on a simulator with instructor feedback ( PPF ) , preoperative practice alone ( PP ) , or feedback alone ( F ) . Trainees then completed a laparoscopic salpingectomy , and the operative performance was evaluated using an assessment tool . RESULTS A total of 18 residents were r and omized and completed the study , 6 in each arm . The mean baseline score on the simulator was comparable in each group ( 67 % for PPF , 68 % for PP , and 70 % for F ) . While the median score on the assessment tool for laparoscopic salpingectomy in the PPF group was the highest , there was no statistically significant difference in assessment scores for the PPF group ( 32.75 ; range , 15 - 36 ) compared to the PP group ( 14.5 ; range , 10 - 34 ) and the F group ( 21.25 ; range , 10.5 - 32 ) . The interrater correlation between the video review ers was 0.87 ( 95 % confidence interval 0.70 - 0.95 ) using the intraclass correlation coefficient . CONCLUSIONS This study suggests that a surgical preoperative practice with instructor feedback may not improve operative technique compared to either preoperative practice or feedback alone BACKGROUND Constructive feedback plays an important role in learning during surgical training .  St and ard feedback is usually given verbally following direct observation of the procedure by a trained assessor . However , such feedback requires the physical presence of expert faculty members who are usually busy and time-constrained by clinical commitments . We aim to evaluate  electronic feedback ( e-feedback ) after video observation of surgical suturing in comparison with st and ard face-to-face verbal feedback . METHODS A prospect i ve , blinded , r and omized controlled trial comparing e-feedback with st and ard verbal feedback was carried out in February 2015 using a vali date d pro formas for assessment . The study participants were 38 undergraduate medical students from the University of Sheffield , UK . They were recorded on video performing the procedural skill , completed a self-evaluation form , and received e-feedback on the same day ( group 1 ) ; observed directly by an assessor , invited to provide verbal self-reflection , and then received st and ard verbal feedback ( group 2 ) . In both groups , the feedback was provided after performing the procedure . The participants returned 2 days later and performed the same skill again . Post study question naire was used to assess the acceptability of each feedback among the participants . RESULTS Overall , 19 students in group 1 and 18 students in group 2 completed the study . Although there was a significant improvement in the overall mean score on the second performance of the task for all participants ( first performance mean 11.59 , second performance mean 15.95 ; p ≤ 0.0001 ) , there was no difference in the overall mean improvement score between group 1 and group 2 ( 4.74 and 3.94 , respectively ; p = 0.49 ) . The mean overall scores  for the e-feedback group at baseline recorded by 2 independent investigators showed good agreement ( mean overall scores of 12.84 and 11.89 ; Cronbach α = 0.86 ) . Post study question naire demonstrated that both e-feedback and st and ard verbal feedback achieved high mean Likert grade s as recorded by the participants ( 4.42 [ range : 2 - 5 ] and 4.71 [ range : 4 - 5 ] , respectively ; p = 0.274 ) . CONCLUSION e-Feedback after watching a video recording appears to be acceptable and is not quantitatively different than st and ard feedback in improving suturing skills among novice trainees . Video assessment of procedural skills is reliable OBJECTIVES The aim of the study was to determine whether individualized coaching improved surgical technical skill in the operating room to a higher degree than current residency training . BACKGROUND Clinical training in the operating room is a valuable opportunity for surgeons to acquire skill and knowledge ; however , it often remains underutilized . Coaching has been successfully used in various industries to enhance performance , but its role in surgery has been insufficiently investigated . METHODS This r and omized controlled trial was conducted at one surgical training program . Trainees undergoing a minimally invasive surgery rotation were r and omized to either  conventional training ( CT ) or comprehensive surgical coaching ( CSC ) . CT included ward and operating room duties , and regular departmental teaching sessions . CSC comprised performance analysis , debriefing , feedback , and behavior modeling . Primary outcome measures were technical performance as measured on global and procedure-specific rating scales , and surgical safety parameters , measured by error count . Operative performance was assessed by blinded video analysis of the first and last cases recorded by the participants during their rotation . RESULTS Twenty residents were r and omized and 18 completed the study . At posttraining the CSC group ( n = 9 ) scored significantly higher on a procedure-specific skill scale compared with the CT group ( n = 9 ) [ median , 3.90 ( interquartile range , 3.68 - 4.30 ) vs 3.60 ( 2.98 - 3.70 ) , P = 0.017 ] , and made fewer technical errors [ 10 ( 7 - 13 ) vs 18 ( 13 - 21 ) , P = 0.003 ] . Significant within-group improvements for all skill metrics were only noted in the CSC group . CONCLUSIONS Comprehensive surgical coaching enhances surgical training and results in skill acquisition superior to conventional training OBJECTIVES The objective of this prospect i ve learning research study is to examine the impact of structured elaborative feedback in practical skills teaching of visual and digital shade matching . MATERIAL S AND METHODS A total of 60 pre clinical dental students participated in the study . The mean average age was 23 years , of which 37 were female ( 61.7 % ) and 23 male ( 38.3 % ) . The participants were r and omly divided into a study and control group ( n = 30 each ) . Recording of shade matching  was carried out on the phantom patient using clinical ly simulated setting s with elaborative feedback in the study group ( T1 ) . Nine items were recorded for  visual shade matching  and six items for  digital shade-taking .  The errors were coded . The lower the total ( max . 30 points ) , the fewer the errors made by students during shade determination . The subject labeled the tooth color using VITA 3D-Master and VITA Easyshade ( Vita Zahnfabrik , Bad Säckingen , Germany ) . RESULTS On comparing the two groups , the study group and the control group showed a similar mean error value at reference time T1 . After intervention ( T2 ) it was possible to achieve a clear improvement in the rate of errors for study group . In the study group there was a significant difference between the ΔE values from time T1 and T2 of visual shade matching ( p < 0.05 ) . The digital ΔE values show in total no significant changes . CONCLUSION Elaborative feedback in conjunction with st and ardized checklists can lead to a substantial improvement among students in terms of visual shade matching . CLINICAL SIGNIFICANCE Correctly determining the tooth shade is an essential treatment step in esthetic reconstructive dentistry . Color is probably one of the most important determinants of esthetics in dentistry . Factors such as lighting conditions , gender , age , experience , and color vision impairment affect the process of shade matching . With an elaborative feedback in conjunction with st and ardized checklists can lead to a substantial improvement among students in terms of visual shade matching . ( J Esthet Restor Dent 28:277 - 286 , 2016 ) BACKGROUND Medical educators have indicated that feedback is one of the main catalysts required for performance improvement . However , medical students appear to be persistently dissatisfied with the feedback that they receive . The purpose of this study was to evaluate learning outcomes and perceptions in students who received feedback compared to those who received general compliments . METHODS All subjects received identical instruction on two-h and ed surgical knot-tying .  Group 1 received specific , constructive feedback on how to improve their knot-tying skill . Group 2 received only general compliments . Performance was videotaped before and after instruction and after feedback . Subjects completed the study by indicating their global level of satisfaction . Three faculty evaluators observed and scored blinded videotapes of each performance . Intra-observer agreement among expert ratings of performance was calculated using 2-way r and om effects intraclass correlation ( ICC ) methods . Satisfaction scores and performance scores were compared using paired sample s t-tests and independent sample s t-tests . RESULTS Performance data from 33 subjects were analysed . Inter-rater reliability exceeded 0.8 for ratings of pre-test , pre-intervention and post-intervention performances . The average performance of students who received specific feedback  improved ( 21.98 versus 15.87 , P<0.001 ) , whereas there was no significant change in the performance score in the group who received only compliments ( 17.00 versus 15.39 , P=0.181 ) The average satisfaction rating in the group that received compliments was significantly higher than the group that received feedback ( 6.00 versus 5.00 , P=0.005 ) . DISCUSSION Student satisfaction is not an accurate measure of the quality of feedback . It appears that satisfaction ratings respond to praise more than feedback , while learning is more a function of feedback BACKGROUND We carried out a prospect i ve , r and omized , 4-arm study including control arm , blinding of examiners to determine effectiveness of computer-based video instruction ( CBVI ) and different types of expert feedback ( concurrent and summary ) on learning of a basic technical skill . METHODS Using bench models , participants were pre-tested on a suturing and instrument knot-tying skill after viewing an instructional video . The students were subsequently assigned r and omly to 4 practice conditions : no additional intervention ( control ) , self study with CBVI , expert feedback during practice trials ( concurrent feedback ) , and expert feedback after practice trials ( summary feedback ) .  All participants underwent 19 trials of practice , over 1 hour , in their assigned training condition . The effectiveness of training was assessed both at an immediate post-test and 1 month later at a retention test . Performance was evaluated using both expert-based ( Global Rating Scores ) and computer-based assessment ( H and Motion Analysis ) . Data were analyzed using repeated- measures ANOVA . RESULTS There were no differences in GRS between groups at pre-test . The CBVI , concurrent feedback and summary feedback methods were equally effective initially for the instruction of this basic technical skill to naive medical students and displayed better performance than control ( control , 12.71 [ 10.79 to 14.62 ] ; CBVI , 16.39 [ 14.38 to 18.40 ] ; concurrent , 16.97 [ 15.79 to 18.15 ] ; summary , 16.09 [ 13.57 to 18.62 ] ; P < .001 each ) . At retention . however , only CBVI and summary feedback groups retained superior suturing and knot-tying performance versus control ( control , 8.13 [ 6.94 to 9.85 ] ; CBVI , 11.92 [ 10.19 to 14.99 ] P = .037 ; concurrent , 9.80 [ 8.55 to 13.45 ] P = .635 ; summary , 111.19 [ 10.27 to 14.29 ] P = .037 ) . H and motion data displayed a similar pattern of results . There were no group differences in the rate of learning ( P > .05 ) . CONCLUSION Our study showed that CBVI can be as effective as  summary expert feedback  in the instruction of basic technical skills to medical students . Thoughtfully incorporated into technical curricula , CBVI can make efficient use of faculty time and serve as a useful pedagogic adjunct for basic skills training . Additionally , our study provides evidence supporting an increased role of  summary feedback  to effectively train novices in technical skills Background In recent times , medical schools have committed to developing good communication and history taking skills in students . However , there remains an unresolved question as to which constitutes the best educational method . Our study aims to investigate whether the use of videotape recording is superior to verbal feedback alone in the teaching of clinical skills and the role of student self- assessment on history taking and communication skills . Methods A r and omized controlled trial was design ed . The study was conducted with 52 of the Dokuz Eylul University Faculty of Medicine second year students . All students ' performances of communication and history taking skills were assessed twice . Between these assessment s , the study group had received both verbal and visual feedback by watching their video recordings on patient interview ; the control group received only verbal feedback from the teacher . Results Although the self- assessment of the students did not change significantly , assessors ' ratings increased significantly for videotaped interviews at the second time . Conclusions Feedback based on videotaped interviews is superior to the feedback given solely based on the observation of assessors OBJECTIVE To determine whether augmenting st and ard feedback on resident performance with a multi source feedback intervention improved pediatric resident communication skills and professionalism . DESIGN R and omized controlled trial . SETTING Children 's Hospital Medical Center , Cincinnati , Ohio , from June 21 , 2004 , to July 7 , 2005 . PARTICIPANTS Thirty-six first-year pediatric residents . INTERVENTIONS Residents assigned to the multi source feedback group ( n = 18 ) completed a self- assessment , received a feedback report about baseline parent and nurse evaluations , and participated in a tailored coaching session in addition to receiving st and ard feedback . Residents in the control group ( n = 18 ) received st and ard feedback only . The control group and their residency directors were blinded to parent and nurse evaluations until the end of the study . MAIN OUTCOME MEASURES Residents ' specific communication skills and professional behaviors were rated by parents and nurses of pediatric patients . Both groups were evaluated at baseline and after 5 months . Scores were calculated on each item as percentage in the highest response category . RESULTS Both groups had comparable baseline characteristics and ratings . Parent ratings increased for both groups . While parent ratings increased more for the multi source feedback group , differences between groups were not statistically significant . In contrast , nurse ratings increased for the multi source feedback group and decreased for the control group . The difference in change between groups was statistically significant for communicating effectively with the patient and family ( 35 % ; 95 % confidence interval , 11.0%-58.0 % ) , timeliness of completing tasks ( 30 % ; 95 % confidence interval , 7.9%-53.0 % ) , and demonstrating responsibility and accountability ( 26 % ; 95 % confidence interval , 2.9%-49.0 % ) . CONCLUSION A multi source feedback intervention positively affected communication skills and professional behavior among pediatric residents OBJECTIVES Complex endovascular skills are difficult to obtain in the clinical environment . Virtual reality ( VR ) simulator training is a valuable addition to current training curricula , but is there a benefit in the absence of expert trainers ? METHODS Eighteen endovascular novices performed a renal artery angioplasty/stenting ( RAS ) on the Vascular Interventional Surgical Trainer simulator .  They were r and omized into three groups : Group A ( n = 6 , control ) , no performance feedback ; Group B ( n = 6 , nonexpert feedback ) , feedback after every procedure from a nonexpert facilitator ; and Group C ( n = 6 , expert feedback ) , feedback after every procedure from a consultant vascular surgeon . Each trainee completed RAS six times . Simulator-measured performance metrics included procedural and fluoroscopy time , contrast volume , accuracy of balloon placement , and h and ling errors . Clinical errors were also measured by blinded video assessment . Data were analyzed using SPSS version 15 . RESULTS A clear learning curve was observed across the six trials . There were no significant differences between the three groups for the general performance metrics , but Group C made fewer errors than Groups A ( P = .009 ) or B ( P = .004 ) . Video-based error assessment showed that Groups B and C performed better than Group A ( P = .002 and P = .000 , respectively ) . CONCLUSION VR simulator training for novices can significantly improve general performance in the absence of expert trainers . Procedure-specific qualitative metrics are improved with expert feedback , but nonexpert facilitators can also enhance the quality of training and may represent a valuable alternative to expert clinical faculty Objectives This study aim ed to explore the value of indi-vidualized feedback on performance , flow and self-efficacy during simulated laparoscopy . Furthermore , we wished to explore attitudes towards feedback and simulator training among medical students . Methods Sixteen medical students were included in the study and r and omized to laparoscopic simulator training with or without feedback . A teacher provided individualized feedback continuously throughout the procedures to the target group . Vali date d question naires and scales were used to evaluate self-efficacy and flow . The Mann-Whitney U test was used to evaluate differences between groups regarding laparoscopic performance ( instrument path length ) , self-efficacy and flow . Qualitative data was collected by group interviews and interpreted using inductive thematic analyses . Results Sixteen students completed the simulator training and question naires . Instrument path length was shorter in the feedback group ( median 3.9 m ; IQR : 3.3 - 4.9 ) as com-pared to the control group ( median 5.9 m ; IQR : 5.0 - 8.1 ) , p<0.05 . Self-efficacy improved in both groups . Eleven students participated in the focus interviews . Participants in the control group expressed that they had fun , whereas participants in the feedback group were more concentrated on the task and also more anxious . Both groups had high ambitions to succeed and also expressed the importance of getting feedback . The authenticity of the training scenario was important for the learning process . Conclusions This study highlights the importance of individualized feedback during simulated laparoscopy training . The next step is to further optimize feedback and to transfer st and ardized and individualized feedback from the simulated setting to the operating room The effects of an intensive feedback method on the teaching performance of ward attending physicians were evaluated . Sixty-four attending physicians were r and omly assigned to one of four experimental groups : ( 1 ) intensive feedback , ( 2 ) videotape control , ( 3 ) question naire feedback , or ( 4 ) question naire control . The method was evaluated using the teachers ' subjective assessment s , ratings of videotapes of ward rounds , and trainee ratings . Seventy-five percent of the intensive feedback group rated their treatment definitely beneficial in contrast to less than 13 percent of teachers in other groups ( p less than 0.001 ) . The intensive feedback group received higher post-treatment videotape ratings than the videotape control group , both on ratings of specific categories of teacher behavior ( p = 0.03 ) and on ratings of overall teaching performance ( p = 0.08 ) . More intensive feedback teachers ( 40 percent ) than videotape control teachers ( 6 percent ) improved their personally identified problem teaching behaviors ( p less than 0.05 ) . Trainee ratings showed no significant difference between study groups . It is concluded that attending physicians can improve their teaching performance . Intensive feedback is one possible method of achieving that goal Background : Evaluation and feedback are two factors that could influence simulation-based medical education and the time when they were delivered contributes their different effects . Aim : To investigate the impact of pre-training evaluation and feedback on medical students ’ performance in basic life support ( BLS ) . Methods : Forty 3rd-year undergraduate medical students were r and omly divided into two groups , C group ( the control ) and pre-training evaluation and feedback group ( E&F group ) , each of 20 . After BLS theoretical lecture , the C group received 45 min BLS training and the E&F group was individually evaluated ( video-taped ) in a mock cardiac arrest ( pre-training evaluation ) . Fifteen minutes of group feedback related with the students ’ BLS performance in pre-training evaluation was given in the E&F group , followed by a 30-min BLS training . After BLS training , both groups were evaluated with  one-rescuer BLS skills in a 3-min mock cardiac arrest scenario ( post-training evaluation ) . The score from the post-training evaluation was converted to a percentage and was compared between the two groups . Results : The score from the post-training evaluation was higher in the E&F group ( 82.9 ± 3.2 % vs. 63.9 ± 13.4 % in C group ) . Conclusions : In undergraduate medical students without previous BLS training , pre-training evaluation and feedback improve their performance in followed BLS training Background Resuscitation guidelines encourage the use of cardiopulmonary resuscitation ( CPR ) feedback devices implying better outcomes after sudden cardiac arrest . Whether effective continuous feedback could also be given verbally by a second rescuer ( “ human feedback ” ) has not been investigated yet . We , therefore , compared the effect of human feedback to a CPR feedback device . Methods In an open , prospect i ve , r and omised , controlled trial , we compared CPR performance of three groups of medical students in a two-rescuer scenario . Group “ sCPR ” was taught st and ard BLS without continuous feedback , serving as control . Group “ mfCPR ” was taught BLS with mechanical audio-visual feedback ( HeartStart MRx with Q-CPR-Technology ™ ) . Group “ hfCPR ” was taught st and ard BLS with human feedback .  Afterwards , 326 medical students performed two-rescuer BLS on a manikin for 8 min . CPR quality parameters , such as “ effective compression ratio ” ( ECR : compressions with correct h and position , depth and complete decompression multiplied by flow-time fraction ) , and other compression , ventilation and time-related parameters were assessed for all groups . Results ECR was comparable between the hfCPR and the mfCPR group ( 0.33 vs. 0.35 , p = 0.435 ) . The hfCPR group needed less time until starting chest compressions ( 2 vs. 8 s , p < 0.001 ) and showed fewer incorrect decompressions ( 26 vs. 33 % , p = 0.044 ) . On the other h and , absolute h and s-off time was higher in the hfCPR group ( 67 vs. 60 s , p = 0.021 ) . Conclusions The quality of CPR with human feedback or by using a mechanical audio-visual feedback device was similar . Further studies should investigate whether extended human feedback training could further increase CPR quality at comparable costs for training OBJECTIVE : To measure the effects of participating in structured oral presentation evaluation sessions  early in pediatric clerkships on students ' subsequent presentations . METHODS : We conducted a single-blind , 3-arm , cluster r and omized controlled trial during pediatric clerkships at Boston University School of Medicine , University of Maryl and School of Medicine , Oregon Health & Science University , and Case Western Reserve University School of Medicine . Blocks of students at each school were r and omly assigned to experience either ( 1 ) no formal presentation feedback ( control ) or a small-group presentation feedback session  early in pediatric clerkships in which students gave live presentations and received feedback from faculty who rated their presentations by using a ( 2 ) single-item ( simple ) or ( 3 ) 18-item ( detailed ) evaluation form . At the clerkship end , overall quality of subjects ’ presentations was rated by faculty blinded to r and omization status , and subjects reported whether their presentations had improved . Analyses included multivariable linear and logistic regressions clustered on clerkship block that controlled for medical school . RESULTS : A total of 476 participants were evenly divided into the 3 arms , which had similar characteristics . Compared with controls , presentation quality was significantly associated with participating in detailed ( coefficient : 0.38 ; 95 % confidence interval [ CI ] : 0.07–0.69 ) but not simple ( coefficient : 0.16 ; 95 % CI : −0.12–0.43 ) feedback sessions . Similarly , student self-report of presentation improvement was significantly associated with participating in detailed ( odds ratio : 2.16 ; 95 % CI : 1.11–4.18 ] but not simple ( odds ratio : 1.89 ; 95 % CI : 0.91–3.93 ) feedback sessions . CONCLUSIONS : Small-group presentation feedback sessions led by faculty using a detailed evaluation form result ed in clerkship students delivering oral presentations of higher quality compared with controls Background Redundant training and feedback are crucial for successful acquisition of skills in simulation trainings . It is still unclear how or how much feedback should best be delivered to maximize its effect , and how learners ’ activity and feedback are optimally blended . To determine the influence of high- versus low-frequency expert feedback on the learning curve of students ’ clinical procedural skill acquisition in a prospect i ve r and omized study . Methods N = 47 medical students were trained to insert a nasogastric tube in a mannequin , including structured feedback in the initial instruction phase at the beginning of the training ( T1 ) , and either additional repetitive feedback after each of their five subsequent repetitions ( high-frequency feedback group , HFF group ; N = 23 ) or additional feedback on just one occasion , after the fifth repetition only ( low-frequency feedback group , LFF group ; N = 24 ) . We assessed a ) task-specific clinical skill performance and b ) global procedural performance ( five items of the Integrated Procedural Performance Instrument ( IPPI ) ; on the basis of expert-rated videotapes at the beginning of the training ( T1 ) and during the final , sixth trial ( T2 ) . Results The two study groups did not differ regarding their baseline data . The calculated ANOVA for task-specific clinical skill performance with the between-subject factor ‘ Group ’ ( HFF vs. LFF ) and within-subject factors ‘ Time ’ ( T1 vs. T2 ) turned out not to be significant ( p < .147 ) . An exploratory post-hoc analyses revealed a trend towards a superior performance of HFF compared to LFF after the training ( T2 ; p < .093 ) , whereas both groups did not differ at the beginning ( T1 ; p < .851 ) . The smoothness of the procedure assessed as global procedural performance , was superior in HFF compared to LFF after the training ( T2 ; p < .004 ) , whereas groups did not differ at the beginning ( T1 ; p < .941 ) . Conclusion Deliberate practice with both high- and low-frequency intermittent feedback results in a strong improvement of students ’ early procedural skill acquisition . High-frequency intermittent feedback , however , results in even better and smoother performance . We discuss the potential role of the cognitive workload on the results . We advocate a thoughtful allocation of tutor re sources to future skills training Abstract Purpose : Medical students receive feedback during clerkships from many different sources : attendings , residents , paramedics , other clerks and even patients . Not all feedback providers have similar impact on learning . One characteristic that is believed to have impact is their credibility to the recipient . This study investigates the effects of feedback provider credibility on  medical student satisfaction , self-efficacy and performance with a trained skill . Methods : A single-blind r and omized controlled between-subjects design was used , with feedback provider credibility ( high – low ) as independent variable and examination of hearing abilities as the task . First year medical students ’ ( n = 68 )  satisfaction , self-efficacy and performance were the dependent variables and were measured both directly after the intervention and after a three-week delay . Results : Credibility did not significantly affect immediate or delayed self-efficacy . Students receiving feedback from a high-credibility source were more satisfied with the feedback . They did not perform significantly better immediately after the feedback intervention , but did so three weeks after the intervention . High credibility was associated with a perception of a negative feedback message and an unsocial feedback provider . Conclusions : Feedback provider credibility impacts satisfaction with feedback and delayed performance . If feedback is not effective in clinical setting s , feedback providers may reconsider their credibility Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists BACKGROUND There are potential advantages to engaging medical students in the feedback process , but efforts to do so have yielded mixed results . The purpose of this study was to evaluate a student-focused feedback instructional session in an experimental setting . METHODS Medical students were assigned r and omly to either the intervention or control groups and then assigned r and omly to receive either feedback or compliments .  Tests of knowledge , skills , and attitudes were given before and after the intervention . RESULTS There was a significant gain of knowledge and skill in the group that received instruction . Satisfaction was higher after compliments in the control group but higher after feedback in the instructional group . There was no change in the subject 's willingness to seek feedback . CONCLUSIONS A student-focused component should be carefully included as part of an overall effort to improve feedback in surgical education . The role of medical student attitudes about feedback requires further investigation CONTEXT Learners can focus on mastery ( i.e. task orientation ) or on learning relative to others ( i.e. ego orientation ) . Previous research suggests task orientations are optimal for learning , a benefit usually linked to the suggestion that qualitative comments are better for learning than quantitative comparisons ( i.e. grade s ) . Yet , it is not clear if the observed effects are attributable to the feedback orientation ( i.e. task versus ego ) , feedback format ( i.e. comments versus numerical scores ) , or an interaction between the two . Here , we aim ed to clarify the effects of feedback orientation and feedback format during simulation-based training in endotracheal intubation . METHODS Forty-one medical students were r and omly assigned to four feedback conditions : Task-oriented Numerical ; Ego-oriented Numerical ; Task-oriented Comment , and Ego-oriented Comment .  Participants performed a total of 20 trials of endotracheal intubation .  Pre-test , post-test and retention test assessment s included the use of h and motion analysis and a global rating scale ( GRS ) . Participants rated feedback credibility , self- assessment and self-confidence using Likert-type scales . Analyses of variance were used to examine group differences . RESULTS Participants ' performance did not differ significantly on the easiest ( p > 0.2 ) or two complex variations of intubation ( p > 0.3 ) . For the moderately difficult variation , analyses of h and motion and GRS data revealed significant group differences at post-test ( p < 0.05 ) , but no differences on the retention test . Analysis of participants ' perceptions showed significant interactions whereby the Ego-oriented Numerical group rated feedback credibility ( p < 0.01 ) higher than the Task-oriented Numerical group ; the two Comment groups did not differ . Some participants recounted negative experiences with the feedback they received . CONCLUSIONS Medical students responded to feedback in ways that challenge previous education research . Specifically , students preferred and improved more in the short term ( but not at retention ) when receiving Ego-oriented feedback in Numerical form . Although learning retention did not differ significantly across feedback conditions , students ' perceptions of themselves and of the teacher and training environment did differ and the implication s for trainees ' future learning must be considered Feedback is considered important to acquire clinical skills . Research evidence shows that feedback does not always improve learning and its effects may be small . In many studies , a variety of variables involved in feedback provision may mask either one of their effects . E.g. , there is reason to believe that the way oral feedback is framed may affect its effect if other variables are held constant . In a r and omised controlled trial we investigated the effect of positively and negatively framed feedback messages on satisfaction , self-efficacy , and performance . A single blind r and omised controlled between-subject design was used , with framing of the feedback message ( positively – negatively ) as independent variable and examination of hearing abilities as the task . First year medical students ’ ( n = 59 )  satisfaction , self-efficacy , and performance were the dependent variables and were measured both directly after the intervention and after a 2 weeks delay . Students in the positively framed feedback condition were significantly more satisfied and showed significantly higher self-efficacy measured directly after the performance . Effect sizes found were large , i.e. , partial η2 = 0.43 and η2 = 0.32 respectively . They showed a better performance throughout the whole study . Significant performance differences were found both at the initial performance and when measured 2 weeks after the intervention : effects were of medium size , respectively r = −.31 and r = −.32 . Over time in both conditions performance and self-efficacy decreased . Framing the feedback message in either a positive or negative manner affects students ’ satisfaction and self-efficacy directly after the intervention be it that these effects seem to fade out over time . Performance may be enhanced by positive framing , but additional studies need to confirm this . We recommend using a positive frame when giving feedback on clinical skills AIMS Feedback is vital for the effective delivery of skills-based education . We sought to compare the s and wich technique and learning conversation structured methods of feedback delivery in competency-based basic life support ( BLS ) training . METHODS Open r and omised crossover study undertaken between October 2014 and March 2015 at the University of Birmingham , United Kingdom . Six-hundred and forty healthcare students undertaking a European Resuscitation Council ( ERC ) BLS course were enrolled , each of whom was r and omised to receive teaching using either the s and wich technique or the learning conversation . Fifty-eight instructors were r and omised to initially teach using either the learning conversation or s and wich technique  , prior to crossing-over and teaching with the alternative technique after a pre-defined time period . Outcome measures included skill acquisition as measured by an end-of-course competency assessment , instructors ' perception of teaching with each feedback technique and c and i date s ' perception of the feedback they were provided with . RESULTS Scores assigned to use of the learning conversation by instructors were significantly more favourable than for the s and wich technique across all but two assessed domains relating to instructor perception of the feedback technique , including all skills-based domains . No difference was seen in either assessment pass rates ( 80.9 % s and wich technique vs. 77.2 % learning conversation ; OR 1.2 , 95 % CI 0.85 - 1.84 ; p=0.29 ) or any domain relating to c and i date s ' perception of their teaching technique . CONCLUSIONS & RELEVANCE This is the first direct comparison of two feedback techniques in clinical medical education using both quantitative and qualitative methodology . The learning conversation is preferred by instructors providing competency-based life support training and is perceived to favour skills acquisition BACKGROUND Previously we evaluated the effectiveness of videotaped feedback as a teaching tool for surgical residents using 3 different core skills in the field of orthopedics . Our results revealed no significant differences in technical skill among surgical residents who were exposed to videotaped feedback and those who were not . Several limitations in the study were identified , including the presence of only a single exposure to videotaped feedback . In the present study we included repeated exposures to determine if skill acquisition was enhanced . METHODS Thirty-three surgical residents were r and omly assigned to receive either no videotaped feedback ( control group ) or repeated video feedback over 3 consecutive weekly practice sessions on a vascular anastomosis bench model . On the fourth week , vascular surgeons blinded to the 2 groups evaluated the residents on the same vascular anastomosis task using a global rating scale and technical checklist forms . RESULTS Twenty-six ( 79 % ) of the residents participated . Independent t tests comparing the scores of each of the 2 different measures between the control group and repeated videotaped feedback group revealed no statistically significant differences . CONCLUSIONS There was no significant difference in the performance of a vascular anastomosis in a bench-training model between residents who were exposed to video feedback over several practice sessions and those who received no video feedback Introduction Provision of expert feedback is widely acknowledged to be an essential component of simulation-based training . However , little is known about the most effective and efficient ways to provide feedback to novices . Optimizing the timing of expert feedback may improve outcomes while reducing re source requirements . The main objective of this study was to determine the impact of providing early versus late expert feedback to novice learners engaged in a flexible ureteroscopy ( fURS ) training curriculum . Methods Senior medical students were recruited to participate in this study . Each student participated in a comprehensive fURS training curriculum that included 3 deliberate , independent practice sessions . Baseline and postcourse fURS skill was assessed for each student using a st and ardized fURS test task . Each student was r and omized to either an early feedback group ( EFG ) or late feedback group ( LFG ) . The EFG participants were provided expert feedback immediately after the baseline skill test , whereas LFG participants were given feedback before their final deliberate , independent practice session . Results Eighteen senior medical students completed the study ( 9 EFG and 9 LFG participants ) . There were no discernible demographic differences between the groups at baseline . When controlling for pretest performance , early rather than late feedback was associated with both shorter postcourse time to completion of the task ( 19.2 vs. 21.5 minutes , P < 0.01 ) and higher performance scores ( 13.1 vs. 10.5 , P < 0.01 ) . Conclusions This study offers preliminary evidence that novice learners may benefit more from early feedback when learning a novel skill . Further study is required
OBJECTIVE Verbal face-to-face feedback on clinical task performance is a fundamental component of health professions education .
Experts argue that feedback is critical for performance improvement , but the evidence is limited .
The aim of this systematic review was to investigate the effect of face-to-face verbal feedback from a health professional  , compared with alternative or no feedback , on the objective workplace task performance of another health professional .