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

Garrett G R J Johnson1,2, Jason Park3, Ashley Vergis1

  • 1Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, MB, Canada.

Surgical Endoscopy
|January 4, 2022
PubMed
Summary

Fundamentals of Laparoscopic Surgery (FLS) training did not improve bile duct cannulation skills. Neither blocked nor random practice schedules offered an advantage, indicating cannulation is a distinct skill not covered by FLS training.

Keywords:
Computer-assisted assessmentContextual interferenceEducationLaparoscopic surgerySimulationTechnical skills

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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.