Lund Sarah, Cook David A, Shaikh Nizamuddin, Shagu Asli, Nelson Megan, Rivera Mariela
Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN.
Office of Applied Scholarship and Education Science, Mayo Clinic College of Medicine and Science, Rochester, MN; Division of General Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.
Surgery. 2022 Nov;172(5):1346-1351. doi: 10.1016/j.surg.2022.06.035. Epub 2022 Aug 19.
Although it seems natural that surgical trainees would learn from demonstrations of a correct performance, evidence outside of surgical education has suggested that error-focused examples may promote error detection and improved procedural task performance. We hypothesized that feedback through error-focused videos would improve procedural learning more than correct-focused videos.
We conducted a randomized controlled trial of video feedback comparing error-focused versus correct-focused examples. The participants were interviewees at our general surgery residency program in December 2020. All of the interviewees performed suturing and knot tying tasks on their interview day (baseline), with 70 common errors identified. For each error, we created an instructional feedback video in two formats: one video demonstrating the error and another demonstrating correct performance. The study participants received feedback videos based on baseline performance errors, with the format randomly assigned. Two blinded raters assessed the baseline and postintervention performances.
Thirty-seven interviewees enrolled and 17 submitted postintervention videos. The postintervention mean performance scores were significantly higher (P = .02) in the error-focused than the correct-focused example group (suturing [maximum score 18]: 16.9 vs 13.9 [difference 2.9; 95% CI 0.7, 5.1]; knot-tying [maximum score 24]: 21.6 vs 17.8 [difference 3.8; 95% CI 0.5, 7.0]). We found no between-group differences in performance time ([error-focused versus correct-focused] suturing: 246 vs 256 s; knot-tying: 170 vs 138 s; P = .08). Mean satisfaction with feedback was similar between groups (error-focused: mean = 5.3 versus correct-focused: mean = 5.2, out of 7; P = .95).
Feedback that highlights errors is associated with better learning of surgical skills than feedback demonstrating correct performance, confirming our hypothesis.
虽然外科实习生通过正确操作示范进行学习似乎是自然而然的，但外科教育之外的证据表明，以错误为重点的示例可能会促进错误检测并提高程序性任务的表现。我们假设，通过以错误为重点的视频提供反馈比以正确为重点的视频能更好地促进程序性学习。
我们进行了一项视频反馈的随机对照试验，比较以错误为重点与以正确为重点的示例。参与者为2020年12月我们普通外科住院医师培训项目的面试者。所有面试者在面试当天（基线）进行缝合和打结任务，共识别出70个常见错误。对于每个错误，我们以两种形式创建了教学反馈视频：一个视频展示错误，另一个视频展示正确操作。研究参与者根据基线表现错误接收反馈视频，视频形式随机分配。两名盲法评分者评估基线和干预后的表现。
37名面试者参与研究，17人提交了干预后的视频。以错误为重点的示例组干预后的平均表现得分显著高于以正确为重点的示例组（P = .02）（缝合[满分18分]：16.9分对13.9分[差值2.9；95%CI 0.7，5.1]；打结[满分24分]：21.6分对17.8分[差值3.8；95%CI 0.5，7.0]）。我们发现两组在操作时间上无差异（[以错误为重点与以正确为重点]缝合：246秒对256秒；打结：170秒对138秒；P = .08）。两组对反馈的平均满意度相似（以错误为重点：平均分 = 5.3对以正确为重点：平均分 = 5.2，满分7分；P = .95）。
突出错误的反馈比展示正确操作的反馈更有助于外科技能的学习，证实了我们的假设。
