title: Self-directed practice schedule enhances learning of suturing skills.
abstract: BACKGROUND
  Most preoperative surgical training programs experience challenges with the availability of expert surgeons to teach trainees. Some research suggests that trainees may benefit from being allowed to actively shape their learning environments, which could alleviate some of the time and resource pressures in surgical training. The purpose of this study was to investigate the effects of self-directed or prescribed practice schedules (random or blocked) on learning suturing skills.
  
  
  METHODS
  Participants watched an instructional video for simple interrupted, vertical mattress and horizontal mattress suturing then completed a pretest to assess baseline skills. Participants were assigned to 1 of 4 practice groups: self-directed practice schedule, prescribed blocked practice schedule, prescribed random practice schedule or matched to the self-directed group (control). Practice of the skill was followed by a delayed (1 h) posttest. Improvement from pretest to posttest was determined based on differences in performance time and expert-based assessments.
  
  
  RESULTS
  Analyses revealed a significant effect of group for difference in performance time of the simple interrupted suture. Random practice did not show the expected advantage for skill learning, but there was an advantage of self-directed practice.
  
  
  CONCLUSIONS
  Self-directed practice schedules may be desirable for optimal learning of simple technical skills, even when expert instruction is available. Instructors must also take into account the interaction between task difficulty and conditions of practice to develop ideal training environments.
authors.affiliation: The Department of Surgery, University of Toronto, Toronto, Ont.
authors.forename: Oleg
authors.initials: O
authors.lastname: Safir
authors.forename: Camille K
authors.initials: CK
authors.lastname: Williams
authors.forename: Adam
authors.initials: A
authors.lastname: Dubrowski
authors.forename: David
authors.initials: D
authors.lastname: Backstein
authors.forename: Heather
authors.initials: H
authors.lastname: Carnahan
mesh_terms: D004501:Education, Medical / Q000379:methods*; D005260:Female; D006801:Humans; D007858:Learning; D008297:Male; D011380:Programmed Instructions as Topic; D013536:Suture Techniques / Q000193:education*; D055815:Young Adult