Varied Practice in Laparoscopy Training: Beneficial Learning Stimulation or Cognitive Overload?

eSpruit, Edward N.; eSpruit, Edward N.; eSpruit, Edward N.; eKleijweg, Luca; eBand, Guido P. H.; eBand, Guido P. H.; eHamming, Jaap F. · 2016 · DOAJ

DOI: 10.3389/fpsyg.2016.00685

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Summary

This study investigates whether varied practice, a technique often recommended in educational literature to enhance motor skill acquisition, is beneficial or detrimental in the context of laparoscopic surgical training. While variability in practice schedules is generally associated with improved long-term retention through the contextual interference effect, laparoscopy involves complex perceptual and motor challenges, such as diminished tactile feedback and counter-intuitive instrument movement. The authors hypothesized that adding variability to such a complex task might induce cognitive overload rather than beneficial learning stimulation, potentially impairing performance. The experimental design involved 52 medical and psychology students with no prior laparoscopic experience, quasi-randomly assigned to a control group (n=24) or an experimental group (n=28). Both groups underwent a three-week training program consisting of three 2-hour sessions, practicing four basic tasks (rubber band, pipe cleaner, bead placement, circle cutting) and one advanced task (intra-corporeal suturing). The control group practiced tasks in a blocked, sequential order. The experimental group practiced the same tasks but with a randomized schedule, more frequent task switching, and inverted viewing conditions for the four basic tasks. Performance was measured via task completion times at baseline, after training sessions two and three, and at a retention test two months later. Results indicated that the experimental group performed significantly worse than the control group on the four basic laparoscopic tasks during training and at the two-month retention session. Specifically, the control group showed superior performance at sessions two and three, as well as at retention, with moderate effect sizes. In contrast, no significant differences were found between groups on the advanced suturing task, which was not practiced under inverted viewing conditions. Both groups improved from baseline to the end of training, but the experimental group’s performance deteriorated or plateaued more significantly during retention for basic tasks. The authors attribute the inferior performance in the experimental group to the inverted viewing conditions, which likely increased cognitive load and disrupted learning, rather than the varied practice schedule itself. The findings suggest that while varied practice is a robust principle in general motor learning, it may not be universally applicable to complex surgical skills training. The study supports the hypothesis that excessive contextual interference, particularly when combined with perceptual distortions like inverted viewing, can lead to cognitive overload that impairs both acquisition and retention. The lack of difference in the advanced task, which lacked the inverted condition, highlights that the specific nature of the variability matters. These results imply that surgical training programs must carefully balance practice variability to avoid overwhelming trainees’ cognitive resources, particularly when introducing complex perceptual-motor adaptations.

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• simulator training transfer