There is a long-standing interest in CSCW on distributed instruction - both in how it differs from collocated instruction as well as the design of tools to reduce any deficiencies. In this study, we leveraged the unique environment of laparoscopic surgery to compare the efficacy and mechanism of instruction in a collocated and distributed condition. By implementing the same instructional technology in both conditions, we are able to evaluate the effect of distance on instruction without the confounding variable of medium of instruction. Surprisingly, our findings revealed trainees perceived a higher perceived quality of instruction in the distributed condition. Further investigation suggests that in a distributed learning environment, trainees change their behavior to attend more to the provided instructions resulting in this higher perceived quality of instruction. Finally, we discuss our findings with regards to media compensation theory, and we provide both social and technical insights on how to better support a distributed instructional process.

Multi-user input over a shared display has been shown to support group process and improve performance. However, current gesturing systems for instructional collaborative tasks limit the input to experts and overlook the needs of novices in making references on a shared display. In this paper, we investigate the effects of a single-user gesturing tool on the communication between trainer and trainees in a laparoscopic surgical training. By comparing the communication structure and content between the trainings with and without the gesturing tool, we show that the communication becomes more imbalanced and the trainees become less active when using the single-user gesturing tool. Our findings highlight the needs to grant all parties the same level of access to a shared display and suggest further directions in designing a shared display for instructional collaborative tasks.

Researchers have shown both performance drawbacks and benefits of using telepointers or similar display overlay-technologies in remote instruction; however, there is not a clear understanding of why there are these performance effects. This poses a challenge in knowing how and when to successfully use or design telepointing technologies in remote instruction. A better understanding is needed with the rise of remote workers in a wide array of industries from oil rig repair to surgery, and the proliferation of heads-up displays or telecommunications devices to support these future work practices. In this study, we explore how the information conveyed through a telepointer is taken up and acted upon by surgical trainees in a laparoscopic surgical telementoring setting. We collected audio and video data of 12 surgical trainees who performed standard laparoscopic surgical tasks on a physical model under the guidance of a surgical trainer. We investigated both action and talk to determine how the telepointer-based information was used. Our findings reveal three main challenges in using the instructional information conveyed through the telepointer including the trainees' tendency of attending to the telepointer instruction as the primary source of information. We argue that the found challenges are socio-technical in nature and require a redesign of the mentoring context as well as the technological tools.