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Impact of continuous training through distributed practice for acquisition of minimally invasive surgical skills



Minimally invasive surgery (MIS) requires the mastery of manual skills and a specific training is required. Apart from residencies and fellowships in MIS, other learning opportunities utilize massive training, mainly with use of simulators in short courses. A long-term postgraduate course represents an opportunity to learn through training using distributed practice.


The objective of this study is to assess the use of distributed practice for acquisition of basic minimally invasive skills in surgeons who participated in a long-term MIS postgraduate course.


A prospective, longitudinal and quantitative study was conducted among surgeons who attended a 1-year postgraduate course of MIS in Brazil, from 2012 to 2014. They were tested through five different exercises in box trainers (peg-transfer, passing, cutting, intracorporeal knot, and suture) in the first (t0), fourth (t1) and last, eighth, (t2) meetings of this course. The time and penalties of each exercise were collected for each participant. Participant skills were assessed based on time and accuracy on a previously tested score.


Fifty-seven surgeons (participants) from three consecutive groups participated in this study. There was a significant improvement in scores in all exercises. The average increase in scores between t0 and t2 was 88% for peg-transfer, 174% for passing, 149% for cutting, 130% for intracorporeal knot, and 120% for suture (p < 0.001 for all exercises).


Learning through distributed practice is effective and should be integrated into a MIS postgraduate course curriculum for acquisition of core skills.

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Corresponding author

Correspondence to Bruce Negrello Nakata.

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Bruce Negrello Nakata, Worens Cavalini, Eduardo A. Bonin, Paolo R. Salvalaggio and Marcelo P. Loureiro have no conflicts of interest or financial ties to disclose.

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Nakata, B.N., Cavalini, W., Bonin, E.A. et al. Impact of continuous training through distributed practice for acquisition of minimally invasive surgical skills. Surg Endosc 31, 4051–4057 (2017).

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  • Minimally invasive surgery
  • Skills acquisition
  • Simulation
  • Training
  • Distributed practice
  • FLS