Contracting retraining schedule improves task speed compared to expanding schedule in novice orthopedic residents

OBJECTIVE: To compare the effects of three spaced retraining schedules (expanding, equal, and contracting interval) on the retention of basic arthroscopic operative skills and cognitive performance after 1 week and 1 month. DESIGN: Twenty-seven orthopedic residents without prior hands-on arthroscopic operative experience were enrolled in a single-center, single-blinded parallel-group randomized controlled trial. Spaced retraining schedules were divided into massed training and retraining phases. During the massed training phase, participants were required to achieve perfect scores in all tasks on the simulator and memorize common knee pathologies During the retraining phase, participants were randomly assigned to Expanding Group (Days 2, 4 and 7), Equal Group (Days 3, 5 and 7), or Contracting Group (Days 4, 6 and 7). Operative and cognitive skills were assessed at four time points (T1-T4) using Tasks 4-6 and the quiz across three groups. SETTING: The study was carried out at the Zhujiang Hospital of Southern Medical University. PARTICIPANTS: 27 orthopedic residents without prior hands-on arthroscopic operative experience. RESULTS: At T3, participants in Contracting group completed knee diagnostic significantly faster than those in Equal group (153.1 ± 20.0s vs. 159.5 ± 19.4s vs. 130.7 ± 20.5s, p = 0.778, p = 0.064, p = 0.014). At T4, both Equal group and Contracting group demonstrated shorter Task 4 completion time than Expanding group (155.2 ± 16.9s vs. 131.7 ± 16.7s vs. 123.7 ± 22.2s, p = 0.031, p  = 0.004, p = 0.685). No significant differences were observed among the three groups in Triangulation III, Loose body removal, or case-based score and quiz score at T3 and T4. CONCLUSIONS: With standardized initial proficiency, a contracting retraining schedule with higher late-sequence practice density improves short to intermediate term retention of basic arthroscopic surgical skills. This schedule is compatible with duty-hour realities and may enhance operative efficiency and safety.