Outcome errors are not necessary for learning orthopedic bone drilling.
BACKGROUND
When learning orthopedic bone drilling, a surgical trainee relies on internally generated and externally provided feedback. The quality and type of feedback often varies in the clinical environment, thus affecting skill acquisition. We investigated the effect of feedback on technical error (plunging) when novice surgical trainees learned bone drilling.


METHODS
Medical students (n = 22) and experienced postgraduate surgical residents (n = 4) drilled bicortical holes in a lamb femur under 1 of 3 feedback conditions: no feedback, self-generated feedback and externally generated feedback. Novices performed a retention test (10 bicortical holes) 1 week after the initial training. We measured plunge depth, the clinically relevant outcome, using computer-assisted methods.


RESULTS
During the initial experiment, the plunges of novices who were exposed to external feedback were similar to those of residents in the experienced group. Novices in the self-generated feedback group plunged more than those in the external feedback group or those in the experienced group (p = 0.002). All novices plunged similarly on the retention test, a measure of true skill learning.


CONCLUSIONS
When learning bicortical bone drilling, feedback related to plunging is not necessary to achieve a competent level of performance. In addition, although external feedback facilitates the achievement of better outcomes, it does not improve learning. It is suggested that to minimize plunging, trainees should learn how to optimize their drilling through the bone rather than how to prevent the plunge.
Khokhotva
Mykola
M
Department of Surgery, University of Toronto, Toronto, Ont.
Backstein
David
D
Dubrowski
Adam
A
D000818:Animals; D004521:Educational Measurement; D030141:Feedback, Psychological; D005269:Femur / Q000601:surgery*; D006801:Humans; D007396:Internship and Residency; D009864:Ontario; D019637:Orthopedic Procedures / Q000193:education*; D013337:Students, Medical