Surgical instructors often predetermine the details of training sessions, such as the order of practised tasks, the duration of practice, and timing and type of feedback, while the trainee remains relatively passive. Such training environments are often not tailored to the informational needs of individual learners and, as such, are likely to be suboptimal learning environments. However, as surgical training programs contend with limited instructor availability and time allotted to teach fundamental technical skills, there is a trend toward the use of self-directed learning modules (e.g., CD-ROM and online programs) that require learners to be more active and independent. Recent research suggests that self-directed practice might assist surgical educators in creating learning environments that better support trainees’ motivation to practise by meeting changing informational needs.1 A study conducted by Jowett and colleagues2 demonstrated that skill performance for tying knots was unaffected by practice enforced after trainees decided they had reached proficiency and did not require further practice. These researchers speculated that the learning environment (e.g., simulation model and instructions) remained unchanged after the trainees reached a certain proficiency on the skill and therefore did not provide any additional benefit to learning. Studies using laboratory, sporting and surgical tasks have shown that motor learning can be facilitated if the learner is able to self-direct various aspects of their training experience, such as frequency of feedback,3–6 access to video instruction6,7 and order of practised tasks.1 Surgical educators have also begun to consider how other aspects of the training environment, such as distribution and schedule of practice, can be optimized to enhance motor learning within time constraints.8 With respect to practice schedules, the literature has shown that performance during acquisition of related tasks practised in a random or unsystematic order (e.g., ACB, BAC, ABC, for 3 tasks A, B and C) is impaired compared with performance of tasks in blocked or drill-type order (e.g., AAA, BBB, CCC). Interestingly, however, after a rest period, performance is better on a delayed test for random practice compared with blocked practice. This phenomenon is referred to as the contextual interference effect9 and is often explained by the forgetting hypothesis,10 which suggests that practice that forces the learner to repetitively forget and recall the required skills, such as random practice, will enhance delayed performance. This is important because, unlike immediate postpractice performance, which often represents transient practice effects, delayed tests are more likely to reflect relatively permanent improvement in ability (i.e., learning).11 Since the motor learning literature has shown the contextual interference effect to be greatest for simple laboratory tasks,12,13 researchers have begun to explore its applicability to more complex tasks in the surgical domain. While these studies have shown divergent results,14–16 they highlight the fact that, in the surgical domain, interactions between performance and practice variability can be affected by task difficulty. While there is some evidence supporting random and self-directed practice in the surgical domain, to our knowledge, no studies have examined both practice schedule and the selection of practice schedule for the same surgical skill. The purpose of this study was to determine how practice schedule (random or blocked) and selection of practice schedule (self-directed or prescribed) contribute to learning of suturing skills. We hypothesized that self-directed and random practice schedules would produce better postpractice performance than the other prescribed practice schedules.