Setting and participants
This study was conducted as a voluntary elective course for medical students in their clinical (3rd to 6th) years at the Medical Faculty of the University of Heidelberg, Germany. The course took place at the MIS Training Center of the Department of General, Visceral and Transplant Surgery. Only laparoscopy-naïve students were included. Students with more than 2 h of prior laparoscopic training were excluded. All participants were informed about the type, extent, and purpose of the study, as well as the possibility to withdraw their consent at any time without disadvantages. SA training was implemented via video clips of recorded LC. Active participation, a fundamental element of SA training, was achieved with interceptive questions (see below). These questions demanded from the participants to distinguish different tissues in the current situation and predict possible outcomes of actions. This type of video-based SA training with interceptive questions was developed following the SA training already described in the literature [