Does supervision matter? A randomized controlled study of laparoscopic simulator training in undergraduate education

Simulation-based training is a cornerstone of surgical education, yet evidence regarding the comparative impact of continuous instructor supervision vs. independent practice for novices remains limited. This study aimed to assess the efficacy of continuous, remote video-guided supervision compared with independent training in laparoscopic simulation for medical students.

A randomized controlled trial was conducted with 20 medical students having no prior laparoscopic experience. Participants were randomized to either a supervision group (n = 8), receiving real-time video-guided instruction, or an independent group (n = 12) engaging in self-directed practice. Training was performed using the Simball Box simulator ("Rope Race" task). Outcome measures included objective task completion times and subjective ratings of perceived difficulty and feedback value via questionnaires.

Both groups demonstrated significant improvement in procedure times from warm-up to the first exercise (Supervised: p < 0.001; Independent: p = 0.020). While no statistically significant difference was found between groups in the primary outcome (performance time in the first unsupervised Rope Race test) the supervised group trended towards faster completion in early exercises. Notably, the supervised group reported significantly lower perceived difficulty post-training (p = 0.049), whereas the independent group perceived a significant reduction in the value of simulator-only feedback (p = 0.003).

Remote real-time supervision significantly reduces perceived difficulty and prevents the devaluation of feedback compared to independent practice. These findings support a hybrid curricular model where resource-intensive supervision is front-loaded to facilitate early psychomotor skill acquisition, followed by independent volume training.