Concurrent versus terminal feedback: it may be better to wait

Feedback is an important feature of simulation-based education. This study investigated the optimal timing of feedback for technical skills learning in novices. Thirty novice endoscopists were pretested on a colonoscopy simulator task. Participants then received feedback either during (concurrent) or after (terminal) each of their 12 practice trials. Effectiveness of training was assessed using an immediate posttest and one week later on retention and transfer tests. Measures included execution time and blinded expert assessments. Both groups performed similarly on the pre-, post-, and retention tests. At transfer, the terminal feedback group performed significantly better as measured by execution time, checklist, and global rating scores. The concurrent feedback group's performance decreased significantly on the transfer test as compared with the posttest and retention test. Not all feedback conditions seem equally effective. The use of terminal feedback resulted in better learning as demonstrated by superior performance during transfer.