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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.

Results show that the virtual pointer system improves the trainer's perception of trainee's performance and this is reflected in the objective performance measures in the third and fourth training runs. The benefit of a virtual pointing and telestration system may be perceived by the trainers early on in training, but this is not evident in objective trainee performance until further mastery has been attained. In addition, the performance improvement of economy of motion specifically shows that the virtual pointer improves the adoption of professional vision- improved ability to see and use laparoscopic video results in more direct instrument movement.

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