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=====Evaluation of distributed practice schedules on retention of a newly acquired surgical skill: A randomized trial=====

====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

====Commentary====

====Comments====
  - National surgical skills curriculum
  - weekly and monthly total number the same ? x 4
    - measure of learning rather than maintenance
 
  - no individual learning curves

  - Statistics - are these the right tests?
  - All outcome measures were analyzed using the nonparametric Mann-Whitney test. Differences between the assessments at the different study time points were analyzed using the nonparametric Wilcoxon’s signed-rank test. Significance for all tests was set at P  .05. Interrater reliability between the 2 expert examiners was assessed using Spearman’s  coefficient. Statistical analyses were carried out using SPSS version 17.0 (SPSS, Inc., Chicago, IL).

====Issues====

  - No drop in scores at 4 months -- but have they completed learning? -- powerlifter story
  - Test is the same - is it learning/ maintenance
  - Model same as test - low fidelity model
  - What is the "MCID" for timing


====Source=====
Mitchell, E. L., Lee, D. Y., Sevdalis, N., Partsafas, A. W., Landry, G. J., Liem, T. K., & Moneta, G. L. (2011). Evaluation of distributed practice schedules on retention of a newly acquired surgical skill: A randomized trial. The American Journal of Surgery, 201(1), 31–39. https://doi.org/10.1016/j.amjsurg.2010.07.040
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