• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • MIS Fellows Course
      • SAGES Robotics Residents and Fellows Courses
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / FLS Skill Acquisition: A Comparison of Blocked versus Interleaved Practice

FLS Skill Acquisition: A Comparison of Blocked versus Interleaved Practice

Steven B Goldin, MD, PhD, Gregory T Horn, BA, Michael J Schnaus, BA, Mark Grichanik, BA, Adam Ducey, BA, Charles Nofsinger, MD, David Hernandez, MD, Murray Shames, MD, Mark Zakaria, MD, Michael T Brannick, PhD. University of South Florida.

Introduction: Fundamentals of laparoscopic surgery (FLS) certification is required for general surgery. FLS training requires a significant time commitment from residents to master the FLS skills. The recommended practice for learning FLS, as stated on the FLS website and in other papers, is to practice tasks one at a time until proficient (blocked practice). Learning theory suggests that interleaved practice, a method in which tasks are rotated rather than learned one at a time, may result in superior learning.

Method: Residents in general surgery, orthopedic surgery, and OB/GYN at USF Morsani College of Medicine were randomized into one of two groups: blocked practice (with a pattern of practice of AABBCCDD) or interleaved practice (with a pattern of practice of ABCDABCD). We compared the performance of residents across groups over 20 trials of each of four FLS tasks (peg transfer, pattern cut, extracorporeal suture, intracorporeal suture). Four weeks later, participants returned to the lab and completed two additional trials of each of the four tasks, in order to assess for longer-term retention of skill.

Results: Performance on each of the tasks, as measured by time to complete a task, improved with increased practice. The interleaved group showed significantly better performance during the learning process, and it showed better performance (but not always significantly so) on retention (Images 1-4). Standardized mean differences in favor of the interleaved group were substantial both at the end of practice and at follow-up (table 1).

Conclusion: Interleaved practice appears to have advantages over blocked practice in developing and retaining FLS skills. Furthermore, in 3 out of 4 of the tasks (peg transfer, extra corporeal, and intracorporeal suturing), the mean retention of skill for the interleaved group was below the mean pass score of PGY-5 residents who passed the FLS exam in 2009-2010. Retention of skill was above the mean for the block group in all 4 tasks. These findings all point to a benefit of interleaved practicing over blocked practice when it comes to FLS preparation. We encourage others to experiment with the method to confirm our findings.
 

Image 1. Peg Transfer

Image 2. Pattern Cut

Image 3. Extracorporeal Suture

 

Image 4. Intracorporeal Suture

Table 1. Standardized mean difference (d) values comparing blocked and interleaved groups on final two (19,20) and follow-up (21,22) trials.

Task Trials 19,20 Trials 21,22
Peg Transfer 12.28 0.99
Pattern Cut 1.36 0.22
Extracorporeal Suture 2.14 0.95
Intracorporeal Suture 1.95 0.88

 

194

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon
  • Click to share on Threads (Opens in new window) Threads
  • Click to share on Bluesky (Opens in new window) Bluesky

Related


sages_adbutler_leaderboard

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals