Comparing Peer vs. Near Peer Feedback in an At-Home Laparoscopic Curriculum

Skilled faculty instructors for laparoscopy are limited. Previously we observed that learners give effective asynchronous feedback to their peers, on par with faculty. We hypothesize that senior resident near-peers can give superior feedback compared with peers by exhibiting advanced technical knowledge, while sharing educational benefits seen in peer feedback.

Junior surgical residents completed a 9-stage curriculum of laparoscopic tasks, with videos uploaded to an online platform. In experimental design, residents were randomized for video review by peers (same level) or near-peers (PGY4). Performance assessed with a task-specific rubric and completion time on an in-person final assessment was compared with t-test. Qualitative analysis of semi-structured interviews with participants compared peer and near-peer feedback.

A single academic institution with residency programs in 2 cities.

Fifty-one invited PGY1-2 residents from 3 specialties (general surgery, OB-GYN, urology).

Final assessment performance was similar among peer (N = 10) and near-peer (N = 7) cohorts as seen in mean (SD) total points (56 [5.5] and 60 [4.3], p = 0.160) or total (SD) time taken (1029 [289] and 887 [278] seconds, p = 0.355) during the assessment. Interviews with 3 participants from the peer group and 5 from near-peer identified 3 major themes. First, different accountability mechanisms relate to assessor role, noting that participants were motivated to maintain reputation in front of their senior resident near-peers; in contrast, working with peers felt more collaborative and supportive. Second, participants noted they learn as they gave and received feedback, and evaluating one's peers provided a sense of community. Third, the value of the curriculum is largely in the curriculum design, including video examples or rubrics which standardize feedback regardless of assessor expertise.

Social learning and the learning environment appeared stronger in the peer feedback group relative to the near-peer group. Additionally, no particular advantage was noted in feedback quality given by near-peers.