Feedback is essential
Learning is limited without feedback. Self-assessment is notoriously inaccurate. And practice makes permanent. If practice occurs without feedback, there is a high likelihood of imperfect practice that gets consolidated. Since motor skills have long retention and unlearning is hard, this is a bad combination.
Brydges et al. Self-regulated learning in simulation-based training: a systematic review and meta-analysis. 2015 Medical Education 49: 368–378
Mahmood and Darzi. The learning curve for a colonoscopy simulator in the absence of any feedback. No feedback, no learning. 2004 Surg Endosc 18: 1224–1230
Learners should self-assess first
We do not self-assess well. However, it is a skill that can be developed. When learners self-assess and get external feedback they develop both superior motor skills and assessment skills.
Quick et al. Surgical resident technical skill self-evaluation: increased precision with training progression. 2017 Journal of surgical research 218:144-149
Patterson et al. Accuracy of subjective performance appraisal is not modulated by the method used by the learner during motor skill acquisition. 2016 Percept Mot Skills. 122(2):650–65.
Schnabel et al. Use of a Formal Assessment Instrument for Evaluation of Veterinary Student Surgical Skills. 2013 Vet Surg 42:488-496
Eva and Regehr. “I’ll Never Play Professional Football” and Other Fallacies of Self-Assessment. 2008. J Cont Educ Health Prof 28(1):14–19
Effective feedback is specific
Feedback should identify what learners should practice or change for optimum performance – and what they should keep doing. Ensure your learners know what they are doing right and give one-two things for them to do differently. Be specific about both; it isn’t helpful to give generalities. With generalities, learners don’t know which components require focused practice.
Archer JC. State of the science in health professional education:effective feedback. 2010 Medical Education 44: 101–108
Feedback helps focus practice
Changing the environment from assessment to coaching improves technical skills in the lab as it does on the field or court. Coaches give real time feedback that is specific and focused on skill development. Coaching puts the emphasis on personal best rather than a grade, leading to more of a growth mindset. Coaching has a strong effect on skill development and also has the potential to improve resilience, resourcefulness and reflective practice (Lovell, 2018).
Lovell B. What do we know about coaching in medical education? A literature review. Medical Education 2018: 52: 376–390
Eppich et al. Structuring Feedback and Debriefing to Achieve Mastery Learning Goals. 2015 Acad Med. 2015;90:1501–1508
Watling et al. Learning culture and feedback: an international study of medical athletes and musicians. 2014 Medical Education 48: 713–723
Positive feedback helps brain consolidation
Positive feedback creates fMRI visible changes in the brain neuronal connections and improves skill consolidation. Plus you are now encouraging learners to keep performing that step accurately.
Sidarta et al. Somatic and Reinforcement-Based Plasticity in the Initial Stages of Human Motor Learning. 2016 The Journal of Neuroscience 36(46):11682–11692
Sugawara et al. Social Rewards Enhance Offline Improvements in Motor Skill. 2012 PLoS ONE 7(11): e48174
Assigning instructors to teams helps identify issues
“Floating” instructors (moving around the room) is the norm for many labs and is less effective at identifying at risk students than is zonal (assigned to a region) instructors. At the UMN we also have a dedicated remediation instructor. By working with at risk students over time, she has been able to identify learning disabilities (particularly dyspraxia) and challenges that had otherwise been missed.
Williamson et al. A Randomized Trial Comparing Freely Moving and Zonal Instruction of Veterinary Surgical Skills Using Ovariohysterectomy Models. 2019 JVME 46(2): 195-204.
Other factors
Visual feedback is ideal. Delayed may be better than immediate. Congruency is needed (feedback that isn’t related is detrimental).
Ossmy and Mukamel. Behavioral and neural effects of congruency of visual feedback during short-term motor learning. 2018 NeuroImage 172:864–873
Wang et al. Effects of Concurrent and Delayed Visual Feedback on Motor Memory Consolidation. 2017 IEEE TRANSACTIONS ON HAPTICS 10(3):350-357.
Video feedback can be helpful when experts aren’t available, at least for some skills.
Al-Jundi et al. A Randomized Controlled Trial to Compare e-Feedback Versus “Standard” Face-to-Face Verbal Feedback to Improve the Acquisition of Procedural Skill. 2017. J Surgical Ed 74(3):390-397/
Instructor credibility is important for feedback reception by the learner.
Telio et al. Feedback and the educational alliance: examining credibility judgements and their consequences. 2016 Medical Education 50: 933–942.
Terminal feedback is better; let the learner practice without stopping to correct every movement.
Hatala et al. Feedback for simulation-based procedural skills training:a meta-analysis and critical narrative synthesis. 2014 Adv in Health Sci Educ 19:251–272
