Document Type : Original Article


1 Shaukat Khanum Memorial Cancer Centre, Lahore, Pakistan

2 Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan


BACKGROUND: The traditional model of teaching surgical skills on “real” patients using graded 
responsibility is being seriously questioned, and there is a paradigm shift toward exploiting simulators. 
There is a lack of clarity on the impact of using simulation as a teaching strategy in novice learners. 
The purpose of our study was to determine if the number and duration of training sessions influence 
the acquisition and retention of laparoscopic skills in naïve learners. There are some data to suggest 
that distributed training programs might have better outcomes, but the results are inconclusive. We 
designed a controlled trial at Aga Khan University, Karachi, with the hypothesis that students trained 
using the distributed method may have enhanced learning outcomes.
MATERIALS AND METHODS: 100 medical students were assigned in a 1:1 ratio to one of two groups. 
Group A underwent a single orientation and supervised practice session of 3 h duration. Group B 
underwent distributed teaching with three learning sessions of 1 h each spread over 3 consecutive 
weeks. Participant scores were analyzed before and after the intervention and at 3‑ and 6‑month 
intervals using repeat measures of ANOVA.
RESULTS: Pretest and immediate posttest scores were comparable between the two groups. The 
3‑month interval test showed significantly higher scores in Group B (difference = −2.90, P < 0.001). 
The 6‑month interval test showed no differences in scores between the two groups (P = 0.178).
CONCLUSIONS: Distributed teaching resulted in significantly enhanced scores at 3‑month 
assessment. However, similar scores at 6 months suggest the need for repeated intervention.


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