Surgery and technical skill decay

BACKGROUND: An increasing number of surgical trainees are taking time out of clinical training for research, parental leave or other interests. A comprehensive review was carried out to evaluate the current evidence on whether and how such time results in surgical skill decay. METHODS: A PubMed, Embase, Web of Science, and Cochrane Library search was performed using the phrase: ("skills decay" OR "skills fade") AND "surgery." All relevant literature was analyzed and summarized. RESULTS: A total of 41 relevant articles were identified. The skills that are most adversely affected by time out of training are technical operative skills and, within those, speed and accuracy in operations. Factors that affect skill decay include the complexity of the task itself, the degree of overlearning (i.e., the skill of the surgeon prior to time out of training) and the retention interval (i.e., the length of time for which the trainee is out of training and whether or not spaced practice is carried out). The articles suggest that simulation may be of assistance in mitigating skill decay; however, this has yet to be fully investigated. CONCLUSIONS: As an increasing number of surgical trainees are taking time away from clinical training for academic research, higher degrees, parental leave, or other interests, further research is required to investigate how to mitigate the resulting surgical skill decay, potentially through the use of simulation.