Eur J Pediatr Surg
DOI: 10.1055/s-0039-1681022
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Spaced Education Improves the Retention of Laparoscopic Suturing Skills: A Randomized Controlled Study

Johannes Boettcher
1  Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Lea Klippgen
1  Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Stefan Mietzsch
1  Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Friederike Grube
1  Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Thomas Krebs
1  Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Robert Bergholz
1  Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Konrad Reinshagen
1  Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
1  Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
› Author Affiliations
Further Information

Publication History

03 November 2018

22 January 2019

Publication Date:
27 February 2019 (eFirst)

Abstract

Background Spaced learning has been shown to be superior in complex motor skill acquisition like laparoscopic suturing and knot tying. By using a pre–post follow-up design, the aim of the study was to evaluate the long-term impact of implementation of the spaced learning concept in laparoscopic training.

Methods To evaluate the effectiveness of spaced learning, subjects were asked to perform four surgeon's square knots on a bowel model within 30 minutes—prior and after 3 hours of hands-on training. To examine the long-term skills, the same students were asked to perform a comparable, but more complex, task (four slip knots in a model of esophageal atresia) 12 months later as follow-up measurement. Total time, knot stability (evaluated via tensiometer), suture accuracy, knot quality (Muresan scale), and laparoscopic performance (Munz checklist) were assessed. Moreover, motivation was accessed using Questionnaire on Current Motivation.

Results Twenty students were included in the study; after simple randomization, 10 were trained using the “spaced learning” concept and 10 via traditional methods. Both groups had comparable baseline characteristics and improved after training significantly, regarding all aspects assessed in this study. Subjects that trained via spaced learning were superior in terms of speed (p = 0.021), knot quality (p = 0.008), and suture strength (p = 0.003). Additionally, spaced learning significantly decreased anxiety (p = 0.029) and probability of success (p = 0.005).

Conclusion The spaced learning concept is very suitable for long-term complex motor skill acquisition, like laparoscopic suturing and knot tying. It is superior to conventional training regarding speed and, most importantly, knot quality and stability, resulting in improved confidence and motivation. Thus, we strongly recommend to incorporate the spaced learning concept into training courses and surgical programs.

Authors' Contributions

Johannes Boettcher: Acquired the data, conceptualized the questionnaire, validated statistics, and approved the final manuscript as submitted. Lea Klippgen: Acquired the data, conceptualized the questionnaire, validated statistics, and approved the final manuscript as submitted. Stefan Mietzsch: Acquired the data, acted as course instructor, and approved the final manuscript as submitted. Friederike Grube: Acquired the data, acted as course instructor, and approved the final manuscript as submitted. Thomas Krebs: Acquired the data, acted as course instructor, and approved the final manuscript as submitted. Robert Bergholz: Acquired the data, acted as course instructor, and approved the final manuscript as submitted. Konrad Reinshagen: Conceptualized and designed the study, and approved the final manuscript as submitted. Michael Boettcher: Conceptualized and designed the study, acquired the data, acted as course instructor, performed statistics, drafted the initial manuscript, and approved the final manuscript as submitted. All authors approved the final manuscript as submitted, and agree to be accountable for all aspects of the work.


Johannes Boettcher and Lea Klippgen contributed equally to the study.


Supplementary Material