Implementing Cognitive Training Into a Surgical Skill Course: A Pilot Study on Laparoscopic Suturing and Knot Tying

Abstract

Mini-invasive surgery-for example, laparoscopy-has challenged surgeons' skills by extending their usual haptic space and displaying indirect visual feedback through a screen. This may require new mental abilities, including spatial orientation and mental representation. This study aimed to test the effect of cognitive training based on motor imagery (MI) and action observation (AO) on surgical skills. A total of 28 postgraduate residents in surgery took part in our study and were randomly distributed into 1 of the 3 following groups: (1) the basic surgical skill, which is a short 2-day laparoscopic course + MI + AO group; (2) the basic surgical skill group; and (3) the control group. The MI + AO group underwent additional cognitive training, whereas the basic surgical skill group performed neutral activity during the same time. The laparoscopic suturing and knot tying performance as well as spatial ability and mental workload were assessed before and after the training period. We did not observe an effect of cognitive training on the laparoscopic performance. However, the basic surgical skill group significantly improved spatial orientation performance and rated lower mental workload, whereas the 2 others exhibited lower performance in a mental rotation test. Thus, actual and cognitive training pooled together during a short training period elicited too high a strain, thus limiting potential improvements. Because MI and AO already showed positive outcomes on surgical skills, this issue may, thus, be mitigated according to our specific learning conditions. Distributed learning may possibly better divide and share the strain associated with new surgical skills learning.

Effect of motor imagery and actual practice on learning professional medical skills

“…Conversely, Jungmann et al (2011) did not show an effect of MI on learning procedures in surgical novices who completed additional mental practice during the interval between the actual training sessions. [37] In massed learning procedure, training is concentrated over a short period of time and is less effective than when the learning sessions are distributed over time, [11] especially for novice practitioners. The distributed procedure also brings more marked progress when the technique to learn is complex.…”

“…It may also be based on mental representation [7][8][9][10], several studies investigating its benefice in learning medical skills. [2,3,4,10,11,12] Motor imagery (MI) is a cognitive process of mentally recalling the sensory information generated by the actual execution. [4,13] through visual or kinesthetic imagery.…”

Updated Statement on Endosurgical Training and Skills

“…use of virtual reality games) of the participants would complete the understanding of spatial abilities. [11][12][13][14].…”

Effect of motor imagery and actual practice on learning professional medical skills

“…With respect to the principle: "never the first time on the patient" [6], simulation may offer a reliable framework without any risk for the patient (practiced on a manikin). Motor imagery (MI) may be associated with actual execution during training sessions [7][8][9][10][11][12], among other methods (e.g. observation, virtual reality).…”

“…[5]. Several studies highlighted the positive effects of MI [17][18][19], particularly in surgery and motor rehabilitation where the cognitive demand is high [10,11,[20][21][22][23][24][25][26][27]. Experienced surgeons view MI as the most effective procedure for complex and stressful situations preparation, probably because the cognitive demands are close to those mobilized during MI, e.g.…”