Randomized Prospective Study Comparing the Effectiveness of Massed and Spaced Learning in Microsurgical Procedures

Study Overview
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Brief Summary
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Title: Randomized prospective study comparing the effectiveness of spaced learning to mass learning in microsurgical procedures. Background: Spacing phenomenon occurs when learning outcomes are greater with the teaching process spread out over time (spaced learning), as opposed to having the same total duration of teaching carried out over a single session (mass learning). Spaced learning has been shown to improve explicit memory tasks including free recall, recognition, cued -recall and frequency estimation. It has been used in various medical specialties with promising results and has been shown to be at least as good as mass training in learning clinical skills such as cardio-pulmonary resuscitation and laparoscopy skills. We aim to test the concept of spaced learning in learning delicate and complex skilled procedures like microsurgery. Our hypothesis is that spaced learning is better than mass learning in acquiring microsurgical suturing skills. Methodology: Medical students with no prior exposure to microsurgical training were randomized into control (mass-learning) and treatment (spaced learning) groups. The students were all taught to handle microsurgical instruments and to suture a prefabricated 4mm wide elastic strip under the microscope using Digital Surgicals MicroTrainer. The control group was taught continuously over 8hrs while the treatment group was taught in 2-hour sessions held each week over a span of 4 weeks. The learning outcomes that were measured included duration taken as well as the placement of the sutures in relation to each other, with the latter being objectively assessed with the use of a computer program from Digital Surgicals. In addition to being assessed at the beginning of the sessions, all participants completed another test 1 month after the completion of the sessions.

Official Title
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Randomized Prospective Study Comparing the Effectiveness of Massed and Spaced Learning in Microsurgical Procedures

Conditions
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Mass Learning, Spaced Learning, Microsurgery

Intervention / Treatment
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* Other: Spaced learning


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Medical students Exclusion Criteria: Anyone who has been exposed to any form of microsurgical training

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 26 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Mass Learning Group<br>Participants underwent an eight-hour microsurgery training course in a single session under the mass-learning format. | |
| Other: Spaced Learning Group<br>Participants underwent two-hour microsurgery training sessions every week for a total of 4 sessions under the spaced learning format. | Other: Spaced learning<br>* Instead of learning over a single session, teaching is carried out over a few weekly sessions but maintaining the overall total number of hours spent on teaching<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration | Duration taken to place pre-determined number of sutures on elastic strip | For the mass learning group, at the end of the 1-day teaching session; for the spaced learning group, at the end of 1 month of teaching sessions. | 
| Suture density and alignment | Another primary outcome measure is the objective scoring of the placement of sutures using a computer program from Digital Surgicals. In particular, the alignment and spacing of the sutures in relation to each other were assessed. | For the mass learning group, at the end of the 1-day teaching session; for the spaced learning group, at the end of 1 month of teaching sessions. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Retention of skills - assessing duration | Duration taken to place pre-determined number of sutures on elastic strip - to assess retention of skills at 1 month after the completion of teaching sessions. | 1 month after the end of the final teaching session | 
| Retention of skills - assessing suture density and alignment | Assess retention of skills by assessing the suture density and alignment at 1 month after the completion of teaching sessions. | 1 month after the end of the final teaching session |