C2B - 09: PEERS VERSUS PROS: FEEDBACK USING STANDARDS IN SIMULATOR TRAINING
Wouter IJgosse, MD, Jan-Maarten Luursema, PhD, Harry van Goor, MD, PhD, FRCS; Radboud University Medical Center

In our laparoscopic simulator training courses, we help students reflect on their performance by providing them with learning curves that are contextualized by performance standards. Such standards are based on expert performance or vendor-provided settings. Creating and updating expert performance based standards is labor intensive and requires the regular availability of expert surgeons. An alternative, easier way to provide learners with feedback is by using standards based on averaged peer performance (peer standards). We compared learning supported by expert standards with learning supported by peer standards.

Sixty-nine medical students starting their surgical internships took part in a four-session laparoscopic basic skills simulator training course. All students performed the Peg transfer task and the Laparoscopic labyrinth task on the FLS video trainer and received feedback based on either peer standards (peer group), expert standards (expert group) or no feedback at all (control group). Performance on the first three sessions was compared using Mann-Whitney U tests for Peg transfer duration, Laparoscopic labyrinth duration, and a single error measure for both tasks. This analysis was done for the peer group versus the expert group, and for the control group versus the combined feedback groups.

No difference in performance was found between peer-feedback based simulator training and expert-feedback based simulator training. Compared to the control group, students who did receive feedback were 14-22% faster but made 61% more errors for tasks on the FLS video trainer. This difference was highly significant for all three Peg transfer and error measures, and for one of three Laparoscopic labyrinth sessions (U range [195-598], average p < .01).

We demonstrated the equivalency of peer-based and expert-based performance feedback for laparoscopic simulator training. Peer performance based standards pose less logistical challenges to generate compared to expert performance based standards and thus facilitate the implementation of competency based training and deliberate practice. A discussion on the use of national versus local standards is needed to guide implementation of peer-based standards. The trade-off between speed and error in the feedback versus control groups analysis indicates feedback causes students to prioritize speed over carefulness, which is not desirable and warrants further investigation.