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Prospective, Randomized Assessment of the Acquisition, Maintenance, and Loss of Laparoscopic Skills

Gallagher, Anthony G. PhD; Jordan-Black, Julie Anne PhD; O'Sullivan, Gerald C. MCh, FRCSI, FACS

doi: 10.1097/SLA.0b013e318251f3d2
Original Articles

Background: Laparoscopic skills are difficult to learn. We, therefore, assessed the factors involved in skill acquisition, maintenance, and loss in 2 prospective, randomized studies.

Methods: In study 1, 24 laparoscopic novices were randomly assigned to a control condition who performed the laparoscopic assessment task; Massed condition who trained on virtual reality (VR) simulation during 1 day or Interval condition who had the same amount of VR training distributed over 3 consecutive days. All groups also completed a novel laparoscopic box-trainer task on 5 consecutive days. In study 2, 16 laparoscopic novices were randomly assigned to a Practice or a No-practice condition. All subjects were required to train on a VR simulation curriculum for the same duration and skill attainment level. The week after completion of training, subjects in the Practice condition were allowed 1 complete practice trial on the simulator. Both groups completed the same tasks 2 weeks after completion of the training.

Results: In study 1, the Interval trained group showed the fastest rate of learning and on completion of training significantly outperformed both the Massed and Control groups (P < 0.0001). In study 2, both groups showed significant skills improvement from training trial T1 to T3 (P < 0.0001). The subjects in the Practice group maintained or improved their skills at 1 week but those in the No practice group showed significant decline of skills at 2 weeks after training completion (P < 0.0001).

Conclusions: Laparoscopic skills are optimally acquired on an Interval training schedule. They significantly decline with 2 weeks of nonuse.

In 2 prospective, randomized studies, it was shown that laparoscopic skills are optimally acquired on an interval practice training schedule and maintained with “minimal” practice. However, skills significantly decline with 2 weeks of nonuse. These results have implications for training configuration at skills centers and in vivo clinical application afterwards.

*School of Medicine, University College Cork, Cork, Ireland

School of Psychology, Queen's University, Belfast, Northern Ireland, UK

Cork Cancer Research Centre, Biosciences Institute, University College Cork, Ireland.

Reprints: Anthony G. Gallagher, PhD, School of Medicine, Brookfield Health Sciences Complex, College Road, University College Cork, Ireland. E-mail:

Disclosure: This research was supported with grants from the European Science Foundation to A.G.G. The authors declare no conflicts of interest.

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