Background: Psychomotor skills for endoscopic surgery can be trained with virtual reality simulators. Distributed training is more effective than massed training, but it is unclear whether distributed training over several days is more effective than distributed training within 1 day. This study aimed to determine which of these two options is the most effective for training endoscopic psychomotor skills. Methods: Students with no endoscopic experience were randomly assigned either to distributed training on 3 consecutive days (group A, n = 10) or distributed training within 1 day (group B, n = 10). For this study the SIMENDO virtual reality simulator for endoscopic skills was used. The training involved 12 repetitions of three different exercises (drop balls, needle manipulation, 30 o endoscope) in differently distributed training schedules. All the participants performed a posttraining test (posttest) for the trained tasks 7 days after the training. The parameters measured were time, nontarget environment collisions, and instrument path length. Results: There were no significant differences between the groups in the first training session for all the parameters. In the posttest, group A (training over several days) performed 18.7% faster than group B (training on 1 day) (p = 0.013). The collision and path length scores for group A did not differ significantly from the scores for group B. Conclusion: The distributed group trained over several days was faster, with the same number of errors and the same instrument path length used. Psychomotor skill training for endoscopic surgery distributed over several days is superior to training on 1 day.Key words: Endoscopic -Laparoscopic -Psychomotor skills -Training -Training schedules -VR simulatorIn recent years, training of psychomotor skills for endoscopic surgery has been shifted from the operation theater to the skills laboratory. To overcome the difficulties in performing endoscopy such as disturbed hand-eye coordination, visual feedback from a threedimensional (3D) environment to a 2D monitor, and working with long instruments, the surgeon has to practice. Several studies have shown that virtual reality (VR) simulators are useful and valid tools for training psychomotor skills such as hand-eye coordination [5,6,8,9,13,14]. Currently, the training of these skills generally is undertaken in structured courses during 1 or 2 days and continues inside the clinic. With the reduced trainee working hours and the increased pressure on the use of health care facilities, training time needs to be used efficiently. It is therefore important to know how long students should train, when they should train, and what influence different training schedules has on the performance.The effect of different training schedules with respect to their distribution has been studied in other fields such as psychology and neuroscience [1,4,11]. Distributed training refers to a practice schedule in which periods of training are interspersed with rest periods. Massed practice refers to ...