Trainee Virtual Reference, Ownership and Recall Needs for Engagement in Decision Making during Telementoring

Surgical telementoring systems support remote instruction, although they often rely on single-user input tools that grant the trainer alone access to pointing and annotation tools. This asymmetry can lead to imbalanced communication and limit trainee participation in decision-making, undermining active learning. While providing trainees with access to shared tools is challenging, as the trainee’s hands are needed to carry out the physical task, prior work has suggested training trainers to verbally engage trainees as an alternative intervention. In this study, we implement a train-the-trainer program in surgical telementoring as an analytic probe to examine what interactional practices and unmet collaboration needs emerge when trainers actively engage trainees within single-user gesturing systems. We analyze audio and video data using Conversation Analysis from 27 surgical trainees performing simulated laparoscopic tasks with remote trainers. Our findings surface persistent coordination challenges rooted in asymmetric access to the shared virtual space. We identify three recurring interactional needs: access to virtual referencing and annotation, co-ownership over the timing and persistence of annotations, and the ability to recall prior visual instructions. We provide socio-technical insights on how to better support a distributed instructional system for learning.