Practice schedules for surgical skills: the role of task characteristics and proactive interference on psychomotor skills acquisition.

OBJECTIVE Although break periods during training sessions are desirable, it is unclear what learners should do during these breaks. Some educators recommend that learners abstain from all task-related practice; however, it is possible that switching to an alternate exercise during break periods can also be effective. The construct of proactive interference (PI) posits that new learning is disrupted by prior learning. PI can be "released" when the nature of the task is changed after several practice trials. In this study, we examined the existence of PI in motor learning under 5 training conditions that differed in contrast to a target exercise. DESIGN Preclinical medical students (n = 75) performed 1 trial of peg transfer as a pretest. Participants were then randomly assigned to 1 of 5 training conditions: mass practice, similar exercise (laparoscopic bean transfer), dissimilar exercise (open suturing), observation, or rest. Participants in the mass practice condition practiced peg transfer in 3 training blocks of 15 minutes, each separated by a 5-minute break. Participants in the other conditions performed 3 training blocks consisting of 15 minutes of peg transfer followed by an interspersed alternate exercise. On completion of 3 training blocks, participants performed 1 additional peg transfer trial as a posttest. RESULTS Despite having trained for the same amount of time on the target task, Analysis of Covariance on posttest scores using pretest scores as the covariate indicated a significant main effect for training condition (p = 0.009). Participants engaging in mass practice performed significantly worse than participants in the dissimilar (p = 0.012), observation (p = 0.022), and rest (p < 0.001) conditions. Additionally, participants in the similar exercise condition performed worse than participants in the rest condition (p = 0.03). CONCLUSIONS When learning a laparoscopic task, a break comprised of dissimilar practice or unrelated activities is effective in releasing PI and improving performance.