Distributed training vs. massed practice for surgical skills training-a systematic review.

Background: Surgical skills training is often conducted using a massed approach. However, using a distributed training schedule may have benefits and increase skill retention. This study aimed to review the evidence for distributed training vs. massed training and recommend how surgical training should be scheduled.

Methods: A systematic review was performed in three databases (MEDLINE, Web of Science, and EMBASE). Two authors screened the articles for inclusion according to the eligibility criteria. Data were extracted for each article, including general information, intervention, outcome, etc. A qualitative synthesis was performed, and the Medical Education Research Study Quality Instrument (MERSQI) was used to assess the methodological quality.

Results: Of 12,088 potential studies screened, 28 were included in the final synthesis. Nineteen of the studies directly compared a distributed and a massed schedule, and thirteen studies combined the massed vs. distributed with various distributed training schedules or only investigated different types of distributed schedules. Of the 19 studies which compared distributed and massed training, 15 found a positive effect of distributed training, and no studies found massed training to be superior. Of the 13 that compared different types of distributed schedules, 6 found a positive effect for one of the distributed schedules, while the remaining 7 studies found no difference between the various training schedules. Only 1 of the 28 studies examined training during different times of the day.

Conclusion: Distributed training is superior to massed training. The optimal distributed schedule seems to be with shorter intervals between sessions. The recommended schedule is one session per day, lasting a maximum of 2 h.