Randomized clinical trial to evaluate mental practice in enhancing advanced laparoscopic surgical performance

Abstract

Mental practice improves technical performance for advanced laparoscopic tasks in the simulated operating room, and allows trainees to maintain or improve their performance despite added stress.

Application of Mental Skills Training in Surgery: A Review of Its Effectiveness and Proposed Next Steps

“…The authors proposed that imagery may be a time-and cost-effective technique to improve surgeons' confidence and knowledge to perform a LC. Additionally, in a recent RCT of the effects of imagery on the laparoscopic jejunojejunostomy performance of senior surgical residents during a simulated crisis scenario, Louridas et al (2015) found that imagery trained participants demonstrated significantly greater advanced laparoscopic performance and technical skill improvements (measured by OSATS and bariatric OSATS) than controls. 24 Another recent RCT studied the effects of imagery on emergency, anesthesia, and surgery residents' teamwork (i.e., assessed by expert raters using the Mayo High Performance Teamwork Scale: MHPTS) during a simulated trauma resuscitation scenario.…”

“…Additionally, in a recent RCT of the effects of imagery on the laparoscopic jejunojejunostomy performance of senior surgical residents during a simulated crisis scenario, Louridas et al (2015) found that imagery trained participants demonstrated significantly greater advanced laparoscopic performance and technical skill improvements (measured by OSATS and bariatric OSATS) than controls. 24 Another recent RCT studied the effects of imagery on emergency, anesthesia, and surgery residents' teamwork (i.e., assessed by expert raters using the Mayo High Performance Teamwork Scale: MHPTS) during a simulated trauma resuscitation scenario. 25 The authors found that the imagery group significantly outperformed controls in teamwork, and concluded that imagery is an effective tool to increase team-based skills.…”

“…Imagery has been shown to be a cost-effective training supplement to physical practice that cuts down on resource consumption, [12][13]17,23,29,31 and enhances surgeons' performance through improved acquisition and performance of surgical skills, [13][14][15][16][18][19]22,24,[29][30] knowledge, 11,23,26 confidence, 23,[26][27] and team-based skills. 25 …”

Mental practice in surgical training

“…Although many surgeons and surgical trainees undoubtedly use forms of MP to prepare for cases, it has only recently been investigated as a formal teaching tool, and to our knowledge is not incorporated into most residency programme curricula. MP, as described in the surgical literature, typically involves a period of relaxation exercises followed by an expert educator reciting a mental imagery script outlining a step‐by‐step operative approach, with emphasis on visual, haptic and cognitive cues . In practice, once a certain level of competency is obtained, it could be performed independently.…”

“…Opportunities for physical practice, however, are increasingly diminished by financial constraints, competition from other trainees, an ever‐expanding number of procedures to learn or work‐to‐rule requirements . MP may augment physical practice in improving the accuracy and precision of surgical movements . Imagining how a movement looks, feels and affects a patient may strengthen cortical representations of the task formed by previous physical practice, or may prime specific neuromuscular pathways .…”