title: Teaching surgical skills: what kind of practice makes perfect?: a randomized, controlled trial.
abstract: OBJECTIVE
  Surgical skills laboratories have become an important venue for early skill acquisition. The principles that govern training in this novel educational environment remain largely unknown; the commonest method of training, especially for continuing medical education (CME), is a single multihour event. This study addresses the impact of an alternative method, where learning is distributed over a number of training sessions. The acquisition and transfer of a new skill to a life-like model is assessed.
  
  
  METHODS
  Thirty-eight junior surgical residents, randomly assigned to either massed (1 day) or distributed (weekly) practice regimens, were taught a new skill (microvascular anastomosis). Each group spent the same amount of time in practice. Performance was assessed pretraining, immediately post-training, and 1 month post-training. The ultimate test of anastomotic skill was assessed with a transfer test to a live, anesthetized rat. Previously validated computer-based and expert-based outcome measures were used. In addition, clinically relevant outcomes were assessed.
  
  
  RESULTS
  Both groups showed immediate improvement in performance, but the distributed group performed significantly better on the retention test in most outcome measures (time, number of hand movements, and expert global ratings; all P values <0.05). The distributed group also outperformed the massed group on the live rat anastomosis in all expert-based measures (global ratings, checklist score, final product analysis, competency for OR; all P values <0.05).
  
  
  CONCLUSIONS
  Our current model of training surgical skills using short courses (for both CME and structured residency curricula) may be suboptimal. Residents retain and transfer skills better if taught in a distributed manner. Despite the greater logistical challenge, we need to restructure training schedules to allow for distributed practice.
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada. Carol-Anne.Moulton@uhn.on.ca
authors.forename: Carol-Anne E
authors.initials: CA
authors.lastname: Moulton
authors.forename: Adam
authors.initials: A
authors.lastname: Dubrowski
authors.forename: Helen
authors.initials: H
authors.lastname: Macrae
authors.forename: Brent
authors.initials: B
authors.lastname: Graham
authors.forename: Ethan
authors.initials: E
authors.lastname: Grober
authors.forename: Richard
authors.initials: R
authors.lastname: Reznick
mesh_terms: D000818:Animals; D002983:Clinical Competence; D004521:Educational Measurement; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008962:Models, Theoretical; D051381:Rats; D013514:Surgical Procedures, Operative / Q000193:education*