title: The Effects of Spacing, Naps, and Fatigue on the Acquisition and Retention of Laparoscopic Skills.
abstract: BACKGROUND
  Earlier research has shown that laparoscopic skills are trained more efficiently on a spaced schedule compared to a massed schedule. The aim of the study was to estimate to what extent the spacing interval, naps, and fatigue influenced the effectiveness of spacing laparoscopy training.
  
  
  METHODS
  Overall 4 groups of trainees (aged 17-41y; 72% female; Nmassed= 40; Nbreak= 35; Nbreak-nap= 37; Nspaced= 37) without prior experience were trained in 3 laparoscopic tasks using a physical box trainer with different scheduling interventions. The first (massed) group received three 100-minute training sessions consecutively on a single day. The second (break) group received the sessions interrupted with two 45-minute breaks. The third (break-nap) group had the same schedule as the second group, but had two 35-minute powernap intervals during the breaks. The fourth (spaced) group had the 3 sessions on 3 consecutive days. A retention session was organized approximately 3 months after training.
  
  
  RESULTS
  The results showed an overall pattern of superior performance at the end of training and at retention for the spaced group, followed by the break-nap, break, and massed group, respectively. The spaced and break-nap group significantly outperformed the break and massed group, with effect sizes ranging from 0.20 to 0.37.
  
  
  CONCLUSIONS
  Spacing laparoscopic training over 3 consecutive days or weeks is superior to massed training, even if the massed training contains breaks. Breaks with sleep opportunity (i.e., lying, inactive, and muted sensory input) enhance performance over training with regular breaks and traditional massed training.
authors.affiliation: Cognitive Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands; Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands; Department of Surgery, Leiden University Medical Center (LUMC), Leiden, The Netherlands. Electronic address: e.n.spruit@fsw.leidenuniv.nl.
authors.forename: Edward N
authors.initials: EN
authors.lastname: Spruit
authors.affiliation: Cognitive Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands; Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands.
authors.forename: Guido P H
authors.initials: GPH
authors.lastname: Band
authors.affiliation: Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands; Department of Clinical Child and Adolescent Studies, Institute of Education and Child Studies, Leiden University, Leiden, The Netherlands.
authors.forename: Kristiaan B
authors.initials: KB
authors.lastname: van der Heijden
authors.affiliation: Department of Surgery, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
authors.forename: Jaap F
authors.initials: JF
authors.lastname: Hamming
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D002983:Clinical Competence; D005221:Fatigue / Q000503:physiopathology; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000379:methods*; D008297:Male; D009426:Netherlands; D061646:Operative Time; D012146:Rest; D012153:Retention, Psychology; D012577:Schools, Medical; D000066908:Simulation Training / Q000379:methods*; D012890:Sleep; D018709:Statistics, Nonparametric; D013647:Task Performance and Analysis; D013997:Time Factors; D055815:Young Adult
keywords: Practice-Based Learning and Improvement; consolidation; laparoscopy; motor skills; powernap; simulation training; spacing