Immediate Auditory Feedback is Superior to Other Types of Feedback for Basic Surgical Skills Acquisition

Mohammed J. Al Fayyadh, Ramy A. Hassan, Zachary K. Tran, Jason W. Kempenich, Leonid Bunegin, Daniel L. Dent, Ross E. Willis

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Objective We examined the effect of timing and type of feedback on medical students’ knot-tying performance using visual versus auditory and immediate versus delayed feedback. We hypothesized that participants who received immediate auditory feedback would outperform those who received delayed and visual feedback. Methods Sixty-nine first- and second-year medical students were taught to tie 2-handed knots. All participants completed 3 pretest knot-tying trials without feedback. Participants were instructed to tie a knot sufficiently tight to stop the “blood” flow while minimizing the amount of force applied to the vessel. Task completion time was not a criterion. Participants were stratified and randomly assigned to 5 experimental groups based on type (auditory versus visual) and timing (immediate versus delayed) of feedback. The control group did not receive feedback. All groups trained to proficiency. Participants completed 3 posttest trials without feedback. Results There were fewer trials with leak (p < 0.01) and less force applied (p < 0.01) on the posttest compared to the pretest, regardless of study group. The immediate auditory feedback group required fewer trials to achieve proficiency than each of the other groups (p < 0.01) and had fewer leaks than the control, delayed auditory, and delayed visual groups (p < 0.02). Conclusions In a surgical force feedback simulation model, immediate auditory feedback resulted in fewer training trials to reach proficiency and fewer leaks compared to visual and delayed forms of feedback.

Original languageEnglish (US)
Pages (from-to)e55-e61
JournalJournal of Surgical Education
Issue number6
StatePublished - Nov 2017


  • Practice-Based Learning and Improvement
  • Systems-Based Practice
  • auditory
  • delayed
  • force feedback
  • immediate
  • surgical education
  • surgical skills
  • visual

ASJC Scopus subject areas

  • Surgery
  • Education


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