Contextual interference for skills development and transfer in laparoscopic surgery: a randomized controlled trial

Area of Science:

• Surgical Education
• Medical Simulation
• Skills Transfer

Background:

• The Fundamentals of Laparoscopic Surgery (FLS) program aims to develop surgical skills for simulation and transfer to real-world procedures.
• Past research suggests random practice schedules (contextual interference) enhance skill retention and transfer compared to blocked schedules.

Purpose of the Study:

• To evaluate if FLS training improves performance on an unpracticed bile duct cannulation task.
• To determine if random practice schedules offer an advantage over blocked schedules in FLS training for this specific task.

Main Methods:

• 44 novices were randomized into three groups: blocked FLS practice, random FLS practice, or no additional training (control).
• Participants trained on FLS tasks, with performance monitored. Skills were assessed on a bile duct cannulation simulation task 4-6 weeks later.
• Outcomes included validated FLS scores, hand-motion analyses, and cannulation task performance metrics.

Main Results:

• All trained participants improved in FLS tasks, but no significant differences were found between blocked, random, and control groups in cannulation task performance.
• Median scores, hand motions, and hand travel distance on the cannulation task showed no significant variations across the groups.
• Cannulation task performance did not correlate with overall FLS performance.

Conclusions:

• Conventional FLS training tasks do not effectively transfer to laparoscopic bile duct cannulation.
• Neither blocked nor random practice schedules provided a relative advantage for cannulation skill acquisition.
• Laparoscopic bile duct cannulation appears to be a distinct skill not adequately addressed by current FLS training and assessment.