Goldin Steven B, Horn Gregory T, Schnaus Michael J, Grichanik Mark, Ducey Adam J, Nofsinger Charles, Hernandez David J, Shames Murray L, Singh Raman P, Brannick Michael T
Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, Florida.
Morsani College of Medicine Scholarly Concentrations Program, University of South Florida, Tampa, Florida.
J Surg Educ. 2014 Jul-Aug;71(4):506-12. doi: 10.1016/j.jsurg.2014.01.001. Epub 2014 Apr 29.
Fundamentals of Laparoscopic Surgery (FLS) certification is required for general surgery. The recommended practice for learning FLS is to practice tasks one at a time until proficient (blocked practice). Learning theory suggests that interleaved practice, a method in which tasks are rotated rather than learned one at a time, may result in superior learning.
Residents were randomized into 1 of 2 groups: blocked practice or interleaved practice. We compared the performance of residents across groups over 20 trials of each of 4 FLS tasks (peg transfer, pattern cut, extracorporeal suture, and intracorporeal suture). Four weeks later, participants returned to the laboratory and completed 2 additional trials of each of the 4 tasks.
Performance on each of the tasks improved with increased practice. The interleaved group showed significantly better performance on the peg transfer task; trends favoring the interleaved group resulted for the other tasks. Standardized mean differences in favor of the interleaved group were substantial both at the end of practice and at follow-up (with the exception of the pattern cut).
Interleaved practice appears to have advantages over blocked practice in developing and retaining FLS skills. We encourage others to experiment with the method to confirm our findings.
普通外科要求具备腹腔镜手术基础（FLS）认证。学习FLS的推荐做法是一次练习一项任务，直至熟练掌握（集中练习）。学习理论表明，间隔练习（一种任务交替而非一次学习一项任务的方法）可能会带来更优的学习效果。
将住院医师随机分为两组之一：集中练习组或间隔练习组。我们比较了两组住院医师在4项FLS任务（移钉、图案切割、体外缝合和体内缝合）中每项任务的20次试验中的表现。四周后，参与者返回实验室，完成4项任务中每项任务的另外2次试验。
随着练习次数增加，每项任务的表现均有所提高。间隔练习组在移钉任务上表现明显更好；其他任务也有倾向于间隔练习组的趋势。在练习结束时和随访时，支持间隔练习组的标准化平均差异都很大（图案切割任务除外）。
在培养和保持FLS技能方面，间隔练习似乎比集中练习更具优势。我们鼓励其他人用这种方法进行试验以证实我们的发现。
