Laparoscopic suturing training using positive or negative feedback: A randomized controlled trial

Abstract

Background: Simulation-based training (SBT) relies heavily on feedback to optimize skill acquisition. While prior studies suggest both positive and negative feedback enhance immediate performance, their effects on skill acquisition and motivational implications remain underexplored. Methods: This randomized controlled trial recruited 42 laparoscopic-naïve medical students, stratified into three groups: positive feedback (emotional encouragement), negative feedback (critical remarks), and no feedback. Participants were assessed at baseline using the intracorporeal suturing assessment tool (ISAT), followed by 2 h of standardized training. One week after training, skill retention was reassessed using ISAT, and motivation was measured using the Intrinsic Motivation Inventory (IMI) with seven items (I). Results: Both feedback groups demonstrated significant skill improvement (positive: 76.8% ΔISAT, p < 0.001; negative: 62.0% ΔISAT, p < 0.001) versus controls (11.2% ΔISAT, p = 0.12). Positive feedback recipients reported higher perceived competence (IMI I4: 5.3 vs 3.6, p = 0.029; IMI I6: 6.2 vs 4.5, p = 0.039) and lower pressure/tension (I2: 2.6 vs 4.3, p = 0.005) compared to negative counterparts. In addition, the perceived competence of trainees was positively correlated with interest/emotion and negatively correlated with pressure/tension in the positive feedback group, while the perceived competence of trainees was positively correlated with pressure/tension in negative feedback group. Conclusion: Both positive and negative feedback are superior to the absence of feedback in enhancing laparoscopic surgical skills. Positive feedback outperforms negative feedback in terms of skill improvement. Participants receiving negative feedback caused more tissue injuries during suturing. Moreover, positive feedback can enhance the intrinsic motivation and self-confidence of trainees in practicing their skills compared to negative feedback.