Journal of Surgical Simulation 2022; 9: 120 - 126

Published: 16 December 2022


Original article

The impact of feedback on laparoscopic skills for surgical residents during COVID-19

Chelsea Harris, Casey Thorburn, Claire Skanes, Robert Kennedy and Chris G. Smith
Corresponding author: Chris G. Smith, Minimally Invasive General Surgeon, 300 Prince Philip Drive, St. John’s, NL, A1B 3V6, Canada. Email:


Background: Feedback is a crucial component in skill development, especially for minimally invasive surgery. Our objective was to determine how real-time video verbal feedback compares with delayed written feedback on junior resident performance in laparoscopic skills using at-home laparoscopic training boxes.

Methods: Junior surgical residents, training at Memorial University, were randomized into three groups: control group (group A), delayed written feedback group (group B), and live verbal feedback group (group C). Data were collected for a period of 5 months. Participants practiced biweekly on a set of prescribed laparoscopic skills, including peg transfer and intracorporeal knot tying. Intervention groups (groups B and C) received either delayed or live feedback with weekly practice from an expert from the surgical field. Pre- and post-testing were completed.

Results: Twelve residents were recruited; one was lost to follow-up. After the data collection period, the average number of pegs transferred correctly increased by 2.8 ± 1.7 for control group A, 3.0 ± 2.6 for group B, and 2.0 ± 1.4 for group C. There was significant group variance as shown by F(2,8) = 5.928, P = 0.026. Post-hoc testing resulted in group B outperforming groups A and C. Groups B and C both improved for the intracorporeal knot-tying task and the number of throws completed; no significant difference was noted between the groups. Qualitative data reported an increase in confidence in completing the tasks at the end of the study for all groups as well as a preference for live verbal feedback versus delayed written feedback.

Conclusions: Access to box trainers allowed residents to practice at home, leading to improved skills and confidence. Participants receiving delayed written feedback showed a significant improvement in peg transfer. Further studies with larger sample sizes should be conducted on how feedback, verbal live versus delayed written feedback, can affect resident outcomes in laparoscopic surgery skills.


surgical education; laparoscopic surgery; simulation; feedback;