title: Improving training of laparoscopic tissue manipulation skills using various visual force feedback types.
abstract: Visual force feedback allows trainees to learn laparoscopic tissue manipulation skills. The aim of this experimental study was to find the most efficient visual force feedback method to acquire these skills. Retention and transfer validity to an untrained task were assessed.
  
  
  
  Medical students without prior experience in laparoscopy were randomized in three groups: Constant Force Feedback (CFF) (N = 17), Bandwidth Force Feedback (BFF) (N = 16) and Fade-in Force Feedback (N = 18). All participants performed a pretest, training, post-test and follow-up test. The study involved two dissimilar tissue manipulation tasks, one for training and one to assess transferability. Participants performed six trials of the training task. A force platform was used to record several force parameters.
  
  
  
  A paired-sample t test showed overall lower force parameter outcomes in the post-test compared to the pretest (p < .001). A week later, the force parameter outcomes were still significantly lower than found in the pretest (p < .005). Participants also performed the transfer task in the post-test (p < .02) and follow-up (p < .05) test with lower force parameter outcomes compared to the pretest. A one-way MANOVA indicated that in the post-test the CFF group applied 50 % less Mean Absolute Nonzero Force (p = .005) than the BFF group.
  
  
  
  All visual force feedback methods showed to be effective in decreasing tissue manipulation force as no major differences were found between groups in the post and follow-up trials. The BFF method is preferred for it respects individual progress and minimizes distraction.
authors.affiliation: Cognitive Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands.
authors.forename: Daan
authors.initials: D
authors.lastname: Smit
authors.affiliation: Cognitive Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands.|Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Edward
authors.initials: E
authors.lastname: Spruit
authors.affiliation: BioMechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands.
authors.forename: Jenny
authors.initials: J
authors.lastname: Dankelman
authors.affiliation: BioMechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands.|Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Tuijthof
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jaap
authors.initials: J
authors.lastname: Hamming
authors.affiliation: BioMechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands. T.Horeman@tudelft.nl.|Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands. T.Horeman@tudelft.nl.
authors.forename: Tim
authors.initials: T
authors.lastname: Horeman
mesh_terms: D000293:Adolescent; D000328:Adult; D002983:Clinical Competence; D004521:Educational Measurement; D056228:Feedback, Sensory; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D008297:Male; D000066908:Simulation Training; D013337:Students, Medical; D055815:Young Adult
keywords: Force; Hybrid box trainer; Laparoscopy; Learning curve; Tissue manipulation skills; Visual feedback