The Association for Surgical Education Evaluation of distributed practice schedules on retention of a newly acquired surgical skill: a randomized trial Erica L. Mitchell, M.D. a, *, Dae Y. Lee, M.D. a , Nick Sevdalis, Ph.D. b , Aaron W. Partsafas, M.D. a , Gregory J. Landry, M.D. a , Timothy K. Liem, M.D. a , Gregory L. Moneta, M.D. a a Division of Vascular Surgery, Oregon Health & Science University, Portland, OR, USA; b Department of Surgery and Cancer, Imperial College London, London, UK Abstract BACKGROUND: Practice influences new skill acquisition. The aim of this study was to prospectively investigate the impact of practice distribution (weekly vs monthly) on complex motor skill (end-side vascular anastomosis) acquisition and 4-month retention. METHODS: Twenty-four surgical interns were randomly assigned to weekly training for 4 weeks or monthly training for 4 months, with equal total training times. Performance was assessed before training, immediately after training, after the completion of distributed training, and 4 months later. RESULTS: There was no statistical difference in surgical skill acquisition and retention between the weekly and monthly scheduled groups, as measured by procedural checklist scores, global rating scores of operative performance, final product analysis, and overall performance or assessment of operative “competence.” CONCLUSIONS: Distributed practice results in improvement and retention of a newly acquired surgical skill independent of weekly or monthly practice schedules. Flexibility in a surgical skills laboratory curriculum is possible without adversely affecting training. © 2011 Elsevier Inc. All rights reserved. KEYWORDS: Motor skill acquisition; Motor skill retention; Distributed practice schedules; Practice distribution; Vascular anastomosis; Vascular skills laboratory; Operative competence; Surgical skills laboratory curriculum Simulation-based training is becoming widely estab- lished within surgical education, and laboratories dedicated to teaching the technical aspects of surgical skill have be- come increasingly popular. 1 Simulation-based training pro- vides a safe, structured environment for motor skills acqui- sition in which basic surgical skills are learned and practiced with the aim of better preparing trainees for the operating room experience. Although simulation-based training is unlikely to replace real operating room experi- ences, it serves as an adjunct for training and allows trainees to improve their performance, overcome learning curves, and simulate the management of procedural complications, all without adverse affects to patients. 2 With increasing constraints placed on residency programs, simulation-based training is gaining momentum. In fact the Residency Re- view Committee in Surgery has now mandated that surgery residency programs provide opportunities for surgical skills laboratory training. 3–6 The Association of Program Directors in Surgery in collaboration with the American College of Surgeons and the American Board of Surgery have developed a national surgical skills curriculum. 7 This curriculum was developed to ensure uniformity in curriculum implementation as well as to provide standardized performance benchmarks for * Corresponding author: Tel.: 503-494-7593; fax: 503-494-4324. E-mail address: mitcheer@ohsu.edu Manuscript received June 29, 2010; revised manuscript July 28, 2010 0002-9610/$ - see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.amjsurg.2010.07.040 The American Journal of Surgery (2011) 201, 31–39