Effect of Performance Feedback Timing on Motor Learning for a Surgical Training Task

Objective: Robot-assisted minimally invasive surgery (RMIS) has become the gold standard for a variety of surgical procedures, but the optimal method of training surgeons for RMIS is unknown. We hypothesized that real-time, rather than post-task, error feedback would better increase learning speed and reduce errors. Methods: Forty-two surgical novices learned a virtual version of the ring-on-wire task, a canonical task in RMIS training. We investigated the impact of feedback timing with multi-sensory (haptic and visual) cues in three groups: (1) real-time error feedback, (2) trial replay with error feedback, and (3) no error feedback. Results: Participant performance was evaluated based on the accuracy of ring position and orientation during the task. Participants who received real-time feedback outperformed other groups in ring orientation. Additionally, participants who received feedback in replay outperformed participants who did not receive any error feedback on ring orientation during long, straight path sections. There were no significant differences between groups for ring position overall, but participants who received real-time feedback outperformed the other groups in positional accuracy on tightly curved path sections. Conclusion: The addition of real-time haptic and visual error feedback improves learning outcomes in a virtual surgical task over error feedback in replay or no error feedback at all. Significance: This work demonstrates that multi-sensory error feedback delivered in real time leads to better training outcomes as compared to the same feedback delivered after task completion. This novel method of training may enable surgical trainees to develop skills with greater speed and accuracy.