Abstract
<title>Abstract</title> <p>Purpose Asynchronous video-based feedback is increasingly used in competency-based surgical education, but its effects during early operative learning remain uncertain. We evaluated whether asynchronous video feedback was associated with higher technical performance or reduced early performance variability in resident-performed laparoscopic cholecystectomy. Methods We conducted a multicenter observational study of general surgery residents from seven residency programs across five cities. Videos were assessed by blinded raters using a five-item Objective Structured Assessment of Technical Skills (OSATS) rubric (range 5–25). Feedback exposure was defined at the resident level. Early milestones were the 3rd, 5th, and 10th recorded cholecystectomy. Analyses compared central performance, dispersion, baseline OSATS, intra-resident change, and mixed-effects models accounting for repeated observations by resident. Results The de-duplicated cohort included 66 residents and 531 unique videos: 281 from feedback-exposed residents and 250 from non-exposed residents. Baseline OSATS was similar between groups. Median OSATS increased with accumulated experience. At the 3rd, 5th, and 10th cases, central OSATS did not differ significantly between groups. At the 10th case, the Feedback group showed a non-significant trend toward lower dispersion (Levene p = 0.070). In mixed-effects modeling, case number was associated with higher OSATS (coefficient 0.93 per 10 cases; p < 0.001), whereas feedback exposure was not (p = 0.905). Simulation exposure showed a favorable descriptive trajectory but was not independently significant (p = 0.151). Conclusions Asynchronous video feedback was not associated with sustained superiority in central OSATS performance. Exploratory analyses suggest feedback may be better studied as an early standardizing intervention that reduces variability, rather than only as a direct performance booster.</p>