Journal of Surgical Simulation 2021; 8: 29 - 36

Published: 11 June 2021


Original article

Impact of formal tuition, supervised practice and feedback on the acquisition of basic laparoscopic skills by novices using a box trainer

Mathew Lyons, Oliver Brown and Brian Ip
Corresponding author: Brian Ip, Dumfries Royal Infirmary, Cargenbridge, Dumfries, DG2 8RX, United Kingdom. Email:


Background and Aim: Laparoscopic box trainers are valuable in the teaching of basic laparoscopic skills. This study aims to define the impact of formal tuition, supervised practice and feedback on the acquisition of basic laparoscopic skills on a box trainer by novice.

Methods: All medical undergraduate attendees of a conference were invited to participate. Participants with previous experience on laparoscopic simulators were excluded. Twenty-eight were randomized to the control group (self-directed learning/practice), 23 to the intervention group (formal tuition/supervised practice/feedback). Baseline and post-intervention performance were assessed using the Global Operative Assessment of Laparoscopic Skills (GOALS) score by blinded assessors.

Results: Both groups showed an overall increase in GOALS score after exposure to the box trainer: control group, 7.79 (SD, 2.23) pre-intervention versus 8.25 (SD 3.04) postintervention; intervention group: 8.43 (SD 2.13) pre-intervention versus 9.35 (SD 2.42) post-intervention (P=0.52). The intervention group showed a greater overall increase in GOALS score compared with the control group, but this was not statistically significant (control mean improvement, + 0.46 [SD 4.08] versus intervention mean improvement + 0.91 [SD 3.84]; P=0.66). A lower performance in depth perception was reported for the control group (mean, -0.07). 

Conclusions: Box trainers are effective in assisting novices to acquire basic laparoscopic skills. Expert tuition, supervised practice and feedback appear to have an additional positive effect.


laparoscopy; simulation; teaching; practice; feedback; GOALS