Scripted mental practice improves advanced laparoscopic surgery performance

1. Scripted mental practice training improved jejunojejunostomy completion, an advanced bariatric laparoscopic procedure, even when faced with a crisis scenario.

2. There was no effect on stress levels or non-technical skills using mental practice scripts

Evidence Rating: Level 1 (Excellent)

Study Rundown: Laparoscopic simulation training has quickly become a core component of surgical residency training. Despite its proven efficacy, several adjuncts to this training are being investigated with the hope of further honing surgical skill. This study examined the efficacy of mental practice, a cognitive rehearsal tool adopted from sports psychology, for improving advanced laparoscopic surgical performance as well as stress level reduction. OSATS (Objective Structured Assessment of Technical Skill) scores improved significantly from baseline in the mental practice group (p=0.003) especially in crisis scenarios as compared to the conventional laparoscopy group, where 40% of subjects deteriorated in crisis situations.

Strengths of this study include randomization with matched controls who were surgeons at the same level of training. Additionally, mental practice scripts were more generalizable to surgeons because they were developed based on subspecialty-trained bariatric surgeons. The study included single institution data, lacked sub-intervention analysis and had a small sample size, limiting the generalizability of the results. Despite these limitations, this study demonstrated that mental practice may be an effective supplementary learning tool for improving technical skills in advanced laparoscopic procedures.

Click to read the study in The British Journal of Surgery

Relevant Reading: Validation of a structured training and assessment curriculum for technical skill acquisition in minimally invasive surgery, Annals of Surgery 2013

In-Depth [randomized controlled trial]: 20 volunteers in their 3^rd or 4^th year of general surgery training were randomized to either conventional or mental practice arms. All participants watched an instructional video on a laparoscopic jejunojejunostomy one week prior to the operation. The mental practice group was taught relaxation exercises, using kinesthetic and visual cues to ‘see and feel’ each step of the procedure. In addition, during the procedure, three crisis scenarios were introduced. The procedures were video recorded and outcomes were assessed using OSATS and MIQ(Mental Imagery Questionnaire). Stress response was assessed using a STAI (State Trait Anxiety Inventory) questionnaire, blood pressure and heart rate changes. Exclusion criteria included those who had performed fewer than 5 of these operations previously, having a systemic illness affecting heart rate or blood pressure, and concurrent use of medications that modify cardiovascular response.

OSATS scores improved significantly from baseline in the mental practice group in crisis scenarios with 7/10 with 5+ point improvement (P=0.003), and the remaining 3/10 with 0-4pt improvement. In the conventional group 2/10 had 5+ point improvements, 4/10 with 0-4pt improvement and the rest deteriorated in crisis situations. The mean OSATS scores were greater across all participants in the mental practice group. While baseline stress increased in both arms in crisis situations it was not significantly different between the groups (STAI conventional (11) vs. mental practice (12) P=0.853.m

More from this author: Introduction of a comprehensive training curriculum in laparoscopic surgery for medical students, Surgery 2014

Image: PD

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