Simulation-based Endourological Skills Training: Does Timing of Expert Feedback Matter?

INTRODUCTION Effective simulation-based training (SBT) methods include the provision of expert feedback. However, the impact of removing content experts from patient care to provide such feedback can be very prohibitive in the long term. As such, it behooves the medical education community to optimize the timing of expert feedback during SBT, for the benefit of the learner as well as the educator and patient. OBJECTIVE The main objective of this study is to determine the impact of providing early versus late expert feedback to novice learners engaged in a simulation-based flexible ureteroscopy (fURS) training curriculum. METHODS Senior medical students were recruited to participate in this pre- and post-test study design. After reviewing an online, fundamentals of fURS lecture, all students received an interactive, hands-on introduction to fURS. Each student then completed an initial standardized pre-study “baseline” skill test (left renal fURS with stone manipulation) followed by 3 deliberate, independent practice (DIP) sessions on fURS, each session lasting 30 minutes and separated by 1 week. After the 3rd DIP session, each student completed a final standardized post-study skill test. Prior to the start of the study, students were randomized to either the “early” feedback group (EFG) or “late” feedback group (LFG). EFG was provided expert feedback immediately following the pre-study skill test while LFG was given feedback before the final DIP session. All pre- and post-study skill test performances were timed and video-recorded, then later scored by 2 blinded, expert endourologists using a validated assessment tool. RESULTS A total of 18 senior medical students completed the study (9 EFG, 9 LFG). Overall, both mean skill task scores (8.0 ±1.4 vs 11.8 ±2.7, p<0.01) and mean skill task time-to-completion (TC - 23.9 ±3.7 vs 20.3 ±3.4mins, p<0.01) improved after the simulation-based fURS training curriculum. There were no demographic differences (p>0.05) and mean pre-study skill task scores were similar between groups (7.9 ±1.5 vs 8.0 ±1.5, p=0.938). Mean pre-study TC was also similar between groups (24.1 ±4.4 vs 23.6 ±3.1mins, p=0.798). Mean post-study scores were significantly better for EFG (13.1 ±2.6 vs 10.5 ±2.2, p=0.034) but there was no significant difference in mean post-study TC (19.4 ±3.1 vs 21.3 ±3.6mins, p=0.243). ANCOVA analysis demonstrated that feedback group strongly predicted post-study TC and performance score (p=0.005 and 0.001, respectively). The seven performance dimensions assessed by the assessment tool were internally consistent for both pre- and post-study test scores with an ICC of 0.974 and 0.983, respectively. CONCLUSIONS This study examining the impact of expert feedback timing during simulation-based fURS skills training demonstrates preliminary evidence that suggests novice learners may benefit more from early feedback when learning a novel skill. Further study is required.