Teaching surgical skills: what kind of practice makes perfect?: a randomized, controlled trial.

Moulton CA, Dubrowski A, MacRae H, Graham B, Grober E, Reznick R. Teaching surgical skills: what kind of practice makes perfect?: a randomized, controlled trial. Ann Surg. 2006;244(3):400-409. The design of many curricula involves teaching students a set of skills all at once. This study was aimed at comparing the effects of scheduling massed practice to scheduling distributed practice on surgical skill acquirement, hypothesizing that splitting training time over a longer period would increase retention of skills. Thirty-eight junior surgical residents were randomly assigned to 1 of 2 experimental groups in this randomized control trial. The first group (massed practice regime) was taught the skill in 4 training periods over the course of 1 day (n = 19). The second group (distributed practice regime) had 4 training periods at the rate of 1 per week, over the course of 4 weeks (n = 19). Both groups learned microvascular anastomosis, which was a new skill. All residents spent the same total amount of time practicing. Assessments were taken pretraining, immediately post training, and 1 month post training. Outcome measures included previously validated tools: expert-based evaluations of performance and computer-based evaluations of performance. Results revealed that the groups showed immediate improvement between pre and post testing, but that there was no significant difference found between the 2 groups. Conversely, significant differences between groups were found in retention (1 month post training), as well as transferability at 1 month post training (testing on a live rat). The clinical significance of this study applies to enhancing retention of skills learned through empirical evidence of pedagogically sound educational theories. The authors concluded that, with respect to retention, teaching students in a distributed schedule, as opposed to a massed schedule, is more beneficial. In light of these findings, efforts should be made to modify massed courses into distributed ones to further retention of skills learned and subsequently quality of patient care. Joanna Lowenthal SPT Stony Brook University Stony Brook, NY