Table 2 Key information and results of all included studies
Study | Aim | Country | Study design | N subjects | Profile of participants | Simulator (type, brand) | Groups / schedules | Total training duration | Spacing interval | Task | Metrics assessed | Testing regime: | Outcome ( p ≤ .05 is considered significant) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mackay et al. 2002 [19] | To determine whether there is an effect of practice distribution in the medical setting. | United Kingdom | Randomized control trial | 41 | Undergraduate and postgraduate students, no previous experience | MIST VR simulator (Mentis, Gothenburg, Sweden) | Spaced 1 (n=14): 4 sessions in total (5 min each), with breaks (2,5 min) in between | 27,5 min | 2,5 min | Laparoscopic transfer-place task: picking an object up with one instrument, transferring it to the other instrument and finally placing in a space on a wire frame. | Time, error, pathlength economy | Post-training: retention test after 5 minutes of rest | Spaced 2 significantly outperformed the massed group (p < .05). |
Spaced 2 (n=13): 3 sessions in total (5 min each) with breaks (2,5 min) in between | 20 min | 2,5 min | |||||||||||
Massed (n=14): 1 session (20 min) | 20 min | none | |||||||||||
Andersen et al. 2015 [34] | To explore the learning curves of VR simulation training of mastoidectomy and the effects of different practice sequences | Denmark | Prospective cohort study | 43 | Undergraduate medical students, no previous experience | Visible ear simulator (Freeware, Internet) | Spaced (n=21): 6 sessions in total, 1 session with 2 tasks (max 1h) at least 3 days spaced from the next session | > 46 days | ≥3 days, mean 7.7 days | Completion of a mastoidectomy with entry into the antrum and posterior tympanotomy | Final product assessment with a 26-item modified welling scale | Assessment of training metrics | Spaced training yielded a significantly higher mean end score compared to massed training (p < .01) |
Massed (n=19): 1 session in total (with 12 tasks) all in 1 day | 1 day | none | |||||||||||
Kang et al. 2015 [35] | To compare different training schedules and identify the most effective. | Korea | Prospective nonrandomized study | 30 | Surgical novices, no previous experience | The Mimic dV-Trainer (Mimic Technologies, Ic. Seattle, WA) | Spaced 1 (n=10): 4 sessions in total, 1 session (1h each) per day for 4 consecutive days | 4 days | 1 day | Suturing exercise, simulating an anastomosis. The user is required to join 2 adjacent tubes by means of 4 sutures | Time to completion | Assessment of training metrics | Median time to completion was significantly lower in spaced 1 group (daily practice) when compared to group 2 (weekly practice) (p < .011). Correlation coefficient calculations of measurements of improvement between each attempt was larger in spaced 1 (daily practice) (-.924) than in spaced 2 (weekly training) (-.899) and the massed group (-.838). The training schedule of spaced 1 was the most effective. |
Spaced 2 (n=10): 4 sessions in total, 1 session (1h each) per week for 4 consecutive weeks | 4 weeks | 7 days | |||||||||||
Massed (n=10): 1 session (4h) | 4 hours | none | |||||||||||
Bjerrum et al. 2016 [36] | To compare two distributed practice schedules | Denmark | Randomized control trial | 20 | Postgraduate medical students, no previous experience | Accutouch (CAE Healthcare, Quebec, Canada) | Spaced 1 (n=10): 3 sessions in total, 1 per week for 3 weeks | 3 weeks | 7 days | Per session training with 3 bronchoscopy simulator cases for a total of 60 minutes. | Procedure time, percent segments entered, wall collisions with the wall obstructing the scope (“red-out”), percent-segments-entered-per-minute | 1.Pre-test 2. Assessment after each of the 3 practice sessions 3. Post training: Retention test after 4 weeks | No main effect of group (p = n.s.), thus no difference in test scores between one-day spaced training and weekly distributed training. |
Spaced 2 (n=10): 3 sessions in total, all in 1 day, spaced by 2 large breaks | 1 day | two breaks | |||||||||||
GĂĽldner et al. 2017 [37] | To analyse the effect of differently scheduled training on surgical performance metrics | Germany | Prospective cohort study | 40 | Novice residents, no previous experience | Da Vinci Surgical Skills Simulator (dVSS; Intuitive Surgical, USA) | Spaced 1 (n=20): 15 sessions in total, 1 session on workdays (1-2 tasks each), followed by a 2-day break, repeated for 3 weeks | 3 weeks | 1 day + 3 days | Exercise 1: pick up rings from a row of pegs and transfer them to another peg. Exercise 2: Pick up 3D objects (wooden letters and number blocks) and set them into corresponding cut-outs. Exercise 3: Draw coloured rings along twisted rods toward the goal of the same colour. Exercise 4: Cauterize and cut dendritic blood vessels, aggravated by rebleeding of the vessels. Exercise 5: Position coloured needles into two colour matched targets of different sizes. | Time to complete, economy of motion, number of instrument collisions, excessive instrument force, instruments out of view, master workspace range, number of drops Overall score (cumulative) Number of missed targets, misapplied energy time, blood loss, and broken vessels | Assessment of training metrics | The spaced group 1 got significantly better overall score, time to complete, and economy of motion in exercise 2 and 3 (p < .05). In the exercise 4 and 5, the daily-spaced group 1 performed significantly better with regard to overall score, time to completion, and economy of motion (p < .05). |
Spaced 2 (n=20): 3 sessions in total, 1 session (with 6 tasks) per week, repeated after 7 days | 3 weeks | 7 days | |||||||||||
Gallagher et al. 2012 [38] | To compare the efficacy of 2 identical laparoscopic skill instructions on 2 different training schedules. | Ireland | Randomized control trial | 24 | Novices with no previous experience | MIST VR simulator (Mentis, Gothenburg, Sweden) | Spaced (n=12): 3 sessions in total, 1 session (with 6 tasks) per day, spaced over 3 consecutive days | 3 days | 1 day | Make as many incisions as possible between evenly spaced (1cm) marks on the long edge of a sheet of paper. | Accuracy of incision | Post training: Completing the cutting task on 5 consecutive days. The massed group was tested on the day of training and the following 4 days. The spaced group was tested on the day of training and the following 2 days | The spaced group had the fastest learning rate overall and on completion of the training outperformed the massed group significantly (p < .01). |
Massed (n=12): 3 sessions in total (with 6 tasks) over 1 day | 1 day | none | |||||||||||
Verdaasdonk et al. 2006 [39] | To determine whether massed or spaced training is the most effective for training endoscopic psychomotor skills. | Netherlands | Randomized control trial | 20 | Students, no previous experience | SIMENDO VR (Delltatech, Delft, The Netherlands) | Spaced (n=10): 3 sessions in total, 1 session (with 4 tasks) per day for 3 consecutive days | 3 days | 1 day | 1. Drop the ball (picking and placing 3 balls in holes) 2. The ring (passing a needle through two rings with both hands) 3. 30° endoscope handling (picking and placing 4 balls on a box with the right hand and an endoscopic camera in the left hand) | Time to completion, collisions of instruments with nontarget environment, pathlength of left and right instrument | Post-training, 7 days after training, identical exercises | The spaced group performed significantly faster (18.7%) than the massed group (p < .05). Although the spaced group had fewer collisions and shorter path length for the right instruments and a longer path length for the left instrument, the differences were not significant. The time score differed significantly for exercise 1 (p < .05) and exercise 2 (p <.05) between the spaced and the massed group, but not for the endoscope handling exercise. |
Massed (n=10): 3 sessions in total, 1 session (with 4 tasks), followed by a break (15 min) | 1 day | 15 min |