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Ding J, Yap ASJ, Thng ZX, Gan NY, Tan JCH, Yip CC. Investigating mental rehearsal's applicability in guiding independent E-learning (IMAGINE) of eye examination skills during the pandemic. MEDICAL TEACHER 2023; 45:658-663. [PMID: 36420808 DOI: 10.1080/0142159x.2022.2145941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND COVID-19's infection control policies have hindered the Deliberate Practice of clinical examinations. Guided Mental Rehearsal (GMR) may overcome this obstacle by facilitating independent, repetitive practice. Underpinned by the 'Motor Simulation Theory,' GMR reinforces similar neuro-circuit activations during physical practice and was proven effective in surgical training. METHODS This prospective, randomized controlled study evaluated the efficacy of GMR versus 'peer-learning' of Confrontational Visual Field Examination (CVFE). Third-year medical-students without clinical Ophthalmology experience were recruited. Controls (n = 40) watched an e-learning instructional video (8-min CVFE tutorial) followed by 6-min of 'peer-learning.' GMR-students (n = 40) had 'peer-learning' replaced by a 6-min GMR audio-recording (CVFE running commentary). Pre-test and post-test MCQs were administered to determine baseline knowledge and knowledge acquisition, respectively. 28 controls and 26 GMR-students performed CVFE on simulated patients with right homonymous hemianopia. Four Ophthalmologists graded their performances using a checklist-based marking scheme. RESULTS Both groups did not exhibit a significant difference in pre-test scores (8.550 vs. 7.947, p = 0.266); outcome of sub-group analysis of CVFE-performing candidates was similar (8.214 vs. 7.833, p = 0.561). Post-test scores were significantly higher than pre-test in both groups (all p < .001), without inter-group difference (14.000 vs. 15.000, p = 0.715). GMR-group had significantly higher scores on CVFE performance than controls (85.354 vs. 73.679%, p = .001). CONCLUSIONS GMR improved psychomotor but not cognitive aspect of learning CVFE. This may be attributable to GMR's theoretical resemblance with physical practice, with additional expert guidance. By enabling independent learning, GMR may also reduce the demand for teaching manpower and thus education cost in the future.
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Affiliation(s)
- Jianbin Ding
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Ophthalmology & Visual Sciences, Khoo Teck Puat Hospital, Singapore, Singapore
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Andrew Shi-Jie Yap
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Ophthalmology & Visual Sciences, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Zheng Xian Thng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Nicola Yi'an Gan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Johnson Choon-Hwai Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chee Chew Yip
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Ophthalmology & Visual Sciences, Khoo Teck Puat Hospital, Singapore, Singapore
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McCormack L, Nesbitt-Hawes E, Deans R, Alonso A, Lim C, Li F, Knapman B, Abbott JA. A review of gynaecological surgical practices for trainees and certified specialists in Australia by volume using MBS and AIHW databases. Aust N Z J Obstet Gynaecol 2022; 62:574-580. [PMID: 35474508 PMCID: PMC9542106 DOI: 10.1111/ajo.13523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a finite volume of surgery performed annually by trainees and certified specialists alike. The detailed assessment of this surgical substrate is important, since it guides true exposure in gynaecological surgical training and practice after fellowship. AIMS This study quantifies the volume and profile of major gynaecological surgical procedures performed in Australia within a specified five-year period and discusses the implications for training and practice. MATERIALS AND METHODS Australian Institute of Health and Welfare data were examined to quantify the total number of major gynaecological procedures performed between 2013 and 2018. Medicare data were analysed to quantify the number of billed procedures. These data were compared with published Australian RANZCOG trainees and operative gynaecologists, to estimate the potential annual average exposure for each procedure. RESULTS Major open, laparoscopic and vaginal surgeries constitute less than 27% of the 600 000 gynaecological procedures performed annually in Australia. Most major gynaecological surgeries are performed at rates lower than 12 cases per year for both trainees and specialists. Over the study period, laparotomies, vaginal hysterectomies and continence procedures decreased, and operative laparoscopies and laparoscopic hysterectomies increased. CONCLUSIONS The volume of available major gynaecological procedures in Australia may not allow sufficient exposure for optimal training and practice for all trainees and specialists in operative gynaecology. This shortfall may compromise the ability to obtain and maintain proficiency in some core gynaecological operative procedures.
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Affiliation(s)
- Lalla McCormack
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Erin Nesbitt-Hawes
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Rebecca Deans
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Anais Alonso
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Claire Lim
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Fiona Li
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Blake Knapman
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
| | - Jason A Abbott
- Gynaecologic Research and Clinical Evaluation (GRACE) group, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
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3
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Edwards TC, Coombs AW, Szyszka B, Logishetty K, Cobb JP. Cognitive task analysis-based training in surgery: a meta-analysis. BJS Open 2021; 5:6460901. [PMID: 34904648 PMCID: PMC8669793 DOI: 10.1093/bjsopen/zrab122] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/24/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Reduced hands-on operating experience has challenged the development of complex decision-making skills for modern surgical trainees. Cognitive task analysis- (CTA-)based training is a methodical solution to extract the intricate cognitive processes of experts and impart this information to novices. Its use has been successful in high-risk industries such as the military and aviation, though its application for learning surgery is more recent. This systematic review aims to synthesize the evidence evaluating the efficacy of CTA-based training to enable surgeons to acquire procedural skills and knowledge. METHODS The PRISMA guidelines were followed. Four databases, including MEDLINE, EMBASE, Web of Science and Cochrane CENTRAL, were searched from inception to February 2021. Randomized controlled trials and observational studies evaluating the training effect of CTA-based interventions on novices' procedural knowledge or technical performance were included. Meta-analyses were performed using a random-effects model. RESULTS The initial search yielded 2205 articles, with 12 meeting the full inclusion criteria. Seven studies used surgical trainees as study subjects, four used medical students and one study used a combination. Surgical trainees enrolled into CTA-based training groups had enhanced procedural knowledge (standardized mean difference (SMD) 1.36 (95 per cent c.i. 0.67 to 2.05), P < 0.001) and superior technical performance (SMD 2.06 (95 per cent c.i. 1.17 to 2.96), P < 0.001) in comparison with groups that used conventional training methods. CONCLUSION CTA-based training is an effective way to learn the cognitive skills of a surgical procedure, making it a useful adjunct to current surgical training.
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Souiki T, Benzagmout M, Alami B, Ibn Majdoub K, Toughrai I, Mazaz K, Boujraf S. Impact of mental imagery on enhancing surgical skills learning in novice's surgeons: a pilot study. BMC MEDICAL EDUCATION 2021; 21:545. [PMID: 34711225 PMCID: PMC8555244 DOI: 10.1186/s12909-021-02987-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Mental imagery (MI) has long been used in learning in both fields of sports and arts. However, it is restrictively applied in surgical training according to the medical literature. Few studies have evaluated its' feasibility and usefulness. The aim of this study is to assess the impact of mental imagery on surgical skills learning among novice's surgeons. MATERIAL AND METHODS In this pilot prospective randomized comparative study; we recruited 17 residents and interns of surgery education curriculum. They were all included in their first semester of the curricula. Two groups were randomly designed. Group (a) including "Mental Imagery" volunteers (n = 9) which benefited from a mental imagery rehearsal exercise prior to physical practice, while the control group (b) (n = 8) didn't underwent any MI process prior to surgery practice. Each participant of both groups was invited to perform an intestinal hand-sewn anastomosis on bovine intestine. Each procedure was evaluated and analyzed according to 14 qualitative criteria while each criterion was scored 0, 1 or 2 respectively assigned to the gesture was not acquired, gesture was performed with effort, or mastered gesture. The final score is 28 for those who master all 14 gestures. A non-parametric statistical comparison between the both studied groups was performed. RESULTS Both groups of surgery students demonstrated equivalent age, sex ratio, laterality, and surgical experience. The mean overall score is significantly higher in the MI group (a) (17.78; SD = 2.42) compared to the control group (b) (10.63, SD = 2.85). However, advanced analysis of individual assessment items showed significant statistical difference between both groups only in 6 out of 14 assessed items. CONCLUSION Indeed, mental imagery will not be able to substitute the traditional learning of surgery for novice surgeons; it is an important approach for improving the technical skills acquisition and shortening the physical learning.
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Affiliation(s)
- Tarik Souiki
- Clinical Neurosciences Laboratory, Faculty of Medicine and Pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP. 1893; Km 2.200, Sidi Hrazem Road, 30000 Fez, Morocco
- Department of Visceral Surgery E3, University Hospital Hassan II, Fez, Morocco
| | - Mohammed Benzagmout
- Clinical Neurosciences Laboratory, Faculty of Medicine and Pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP. 1893; Km 2.200, Sidi Hrazem Road, 30000 Fez, Morocco
| | - Badreeddine Alami
- Clinical Neurosciences Laboratory, Faculty of Medicine and Pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP. 1893; Km 2.200, Sidi Hrazem Road, 30000 Fez, Morocco
| | - Karim Ibn Majdoub
- Department of Visceral Surgery E3, University Hospital Hassan II, Fez, Morocco
| | - Imane Toughrai
- Department of Visceral Surgery E3, University Hospital Hassan II, Fez, Morocco
| | - Khalid Mazaz
- Department of Visceral Surgery E3, University Hospital Hassan II, Fez, Morocco
| | - Saïd Boujraf
- Clinical Neurosciences Laboratory, Faculty of Medicine and Pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP. 1893; Km 2.200, Sidi Hrazem Road, 30000 Fez, Morocco
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Wheble R, Channon SB. What Use is Anatomy in First Opinion Small Animal Veterinary Practice? A Qualitative Study. ANATOMICAL SCIENCES EDUCATION 2021; 14:440-451. [PMID: 32558304 DOI: 10.1002/ase.1995] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 05/14/2020] [Accepted: 06/11/2020] [Indexed: 06/11/2023]
Abstract
Despite the uncontested importance of anatomy as one of the foundational aspects of undergraduate veterinary programs, there is still limited information available as to what anatomy knowledge is most important for the graduate veterinarian in their daily clinical work. The aim of this study was therefore to gain a deeper understanding of the role that anatomy plays in first opinion small animal veterinary practice. Using ethnographic methodologies, the authors aimed to collect rich qualitative data to answer the question "How do first opinion veterinarians use anatomy knowledge in their day-to-day clinical practice?" Detailed observations and semi-structured interviews were conducted with five veterinarians working within a single small animal first opinion practice in the United Kingdom. Thematic analysis was undertaken, identifying five main themes: Importance; Uncertainty; Continuous learning; Comparative and dynamic anatomy; and Communication and language. Anatomy was found to be interwoven within all aspects of clinical practice; however, veterinarians were uncertain in their anatomy knowledge. This impacted their confidence and how they carried out their work. Veterinarians described continually learning and refreshing their anatomy knowledge in order to effectively undertake their role, highlighting the importance of teaching information literacy skills within anatomy curricula. An interrelationship between anatomy use, psychomotor, and professional skills was also highlighted. Based on these findings, recommendations were made for veterinary anatomy curriculum development. This study provides an in-depth view within a single site small animal general practice setting: further work is required to assess the transferability of these findings to other areas of veterinary practice.
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Affiliation(s)
| | - Sarah Beth Channon
- Department of Comparative Biomedical Sciences, The Royal Veterinary College, London, United Kingdom
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Cragg J, Mushtaq F, Lal N, Garnham A, Hallissey M, Graham T, Shiralkar U. Surgical cognitive simulation improves real-world surgical performance: randomized study. BJS Open 2021; 5:6280341. [PMID: 34021326 PMCID: PMC8140200 DOI: 10.1093/bjsopen/zrab003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/17/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite the acknowledgement of human factors, application of psychological methods by surgeons to improve surgical performance is sparse. This may reflect the paucity of evidence that would help surgeons to use psychological techniques effectively. There is a need for novel approaches to see how cognitive training might be used to address these challenges. METHODS Surgical trainees were divided into intervention and control groups. The intervention group received training in surgical cognitive simulation (SCS) and was asked to apply the techniques while working in operating theatres. Both groups underwent procedure-based assessment based on the UK and Ireland Intercollegiate Surgical Curriculum Programme (ISCP) before the training and 4 months afterwards. Subjective evaluations of SCS application were obtained from the intervention group participants. RESULTS Among 21 participants in the study, there was a statistically significant improvement in 11 of 16 procedure-based assessment domains (P < 0.050) as well as a statistically significant mean reduction in time to complete the procedure in the intervention group (-15.98 versus -1.14 min; P = 0.024). Subjectively, the intervention group experienced various benefits with SCS, especially in preoperative preparedness, intraoperative focus, and overall performance. CONCLUSION SCS training has a statistically significant impact in improving surgical performance. Subjective feedback suggests that surgeons are able to apply it in practice. SCS may prove a vital adjunct for skill acquisition in surgical training.
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Affiliation(s)
- J Cragg
- Correspondence to: Department of Vascular Surgery, Russells Hall Hospital, Pensett Road, Dudley DY1 2HQ, UK (e-mail: )
| | - F Mushtaq
- School of Psychology, University of Leeds, Leeds, UK
| | - N Lal
- Department of General Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - A Garnham
- Department of Vascular Surgery, New Cross Hospital, Wolverhampton, UK
| | - M Hallissey
- Department of General Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - T Graham
- Postgraduate School of Surgery, West Midlands Deanery, UK
| | - U Shiralkar
- Worcestershire Health and Care NHS trust, Worcestershire, UK
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7
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Goble MSL, Raison N, Mekhaimar A, Dasgupta P, Ahmed K. Adapting Motor Imagery Training Protocols to Surgical Education: A Systematic Review and Meta-Analysis. Surg Innov 2021; 28:329-351. [PMID: 33710912 PMCID: PMC8264649 DOI: 10.1177/1553350621990480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. Motor imagery (MI) is widely used to improve technical skills in sports and has been proven to be effective in neurorehabilitation and surgical education. This review aims to identify the key characteristics of MI protocols for implementation into surgical curricula. Design. This study is a systematic review and meta-analysis. PubMed, MEDLINE, Embase and PsycINFO databases were systematically searched. The primary outcome was the impact of MI training on measured outcomes, and secondary outcomes were study population, MI intervention characteristics, study primary outcome measure and subject rating of MI ability (systematic review registration: PROSPERO CRD42019121895). Results. 456 records were screened, 60 full texts randomising 2251 participants were reviewed and 39 studies were included in meta-analysis. MI was associated with improved outcome in 35/60 studies, and pooled analysis also showed improved outcome on all studies with a standardised mean difference of .39 (95% CI: .12, .67, P = .005). In studies where MI groups showed improved outcomes, the median duration of training was 24 days (mode 42 days), and the median duration of each individual MI session was 30 minutes (range <1 minute-120 minutes). Conclusions. MI training protocols for use in surgical education could have the following characteristics: MI training delivered in parallel to existing surgical training, in a flexible format; inclusion of a brief period of relaxation, followed by several sets of repetitions of MI and a refocusing period. This is a step towards the development of a surgical MI training programme, as a low-cost, low-risk tool to enhance practical skills.
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Affiliation(s)
- Mary S L Goble
- MRC Centre for Transplantation, Guy's Hospital, 4616King's College London, UK
| | - Nicholas Raison
- MRC Centre for Transplantation, Guy's Hospital, 4616King's College London, UK
| | - Ayah Mekhaimar
- MRC Centre for Transplantation, Guy's Hospital, 4616King's College London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital, 4616King's College London, UK.,Department of Urology, 4616Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, 4616King's College London, UK.,Department of Urology, 4616Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
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Collet C, Hajj ME, Chaker R, Bui-Xuan B, Lehot JJ, Hoyek N. Effect of motor imagery and actual practice on learning professional medical skills. BMC MEDICAL EDUCATION 2021; 21:59. [PMID: 33461539 PMCID: PMC7814611 DOI: 10.1186/s12909-020-02424-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 12/06/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The peripheral venous catheter is the most frequently used medical device in hospital care to administer intravenous treatment or to take blood samples by introducing a catheter into a vein. The aim of this study was to examine the effect of motor imagery associated with actual training on the learning of peripheral venous catheter insertion into a simulated venous system. METHOD This was a prospective monocentre study in 3rd year medical students. Forty medical students were assigned to the experimental group (n = 20) performing both real practice and motor imagery of peripheral venous catheter insertion or to the control group (n = 20) trained through real practice only. We also recruited a reference group of 20 professional nurses defining the benchmark for a target performance. RESULTS The experimental group learned the peripheral venous catheter insertion faster than the control group in the beginning of learning phase (p < 0.001), reaching the expected level after 4 sessions (p = .87) whereas the control group needed 5 sessions to reach the same level (p = .88). Both groups were at the same level at the end of the scheduled training. CONCLUSIONS Therefore, motor imagery improved professional motor skills learning, and limited the time needed to reach the expected level. Motor imagery may strengthen technical medical skill learning.
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Affiliation(s)
- Christian Collet
- Inter-university Laboratory of Human Motor Performance (LIBM - EA 7424), Université de Lyon, Université Claude Bernard, Lyon 1, 27 & 29 Boulevard du 11 Novembre 1918, F-69622, Villeurbanne Cedex, France
| | - Mahmoud El Hajj
- Inter-university Laboratory of Human Motor Performance (LIBM - EA 7424), Université de Lyon, Université Claude Bernard, Lyon 1, 27 & 29 Boulevard du 11 Novembre 1918, F-69622, Villeurbanne Cedex, France
| | - Rawad Chaker
- ISPEF, Laboratory of Education Cultures and Politics, University Lumière Lyon 2, Lyon, Cedex 07, 69365, France
| | - Bernard Bui-Xuan
- Health Services and Performance Research (HESPER - EA7425), Faculty of Medicine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon 1, 8, Avenue Rockefeller, F-69008, Lyon, France
- Hospices Civils de Lyon, Neurological Hospital, Boulevard Pinel, 69 500, Lyon, Bron, France
| | - Jean-Jacques Lehot
- Health Services and Performance Research (HESPER - EA7425), Faculty of Medicine Lyon-Est, Université de Lyon, Université Claude Bernard Lyon 1, 8, Avenue Rockefeller, F-69008, Lyon, France
- Hospices Civils de Lyon, Neurological Hospital, Boulevard Pinel, 69 500, Lyon, Bron, France
| | - Nady Hoyek
- Inter-university Laboratory of Human Motor Performance (LIBM - EA 7424), Université de Lyon, Université Claude Bernard, Lyon 1, 27 & 29 Boulevard du 11 Novembre 1918, F-69622, Villeurbanne Cedex, France.
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Yiasemidou M, Mushtaq F, Basheer M, Galli R, Panagiotou D, Stock S, Preston N, Mon-Williams M, Jayne DG, Miskovic D. Patient-specific mental rehearsal with three-dimensional models before low anterior resection: randomized clinical trial. BJS Open 2020. [PMCID: PMC7944490 DOI: 10.1093/bjsopen/zraa004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background It was hypothesized that preparing for a surgical procedure, taking into account individual patient characteristics, may facilitate the procedure and improve surgical quality. The aim of this study was to compare different case-specific, preoperative mental rehearsal methods before minimally invasive rectal cancer surgery. Methods In this RCT, patients were allocated in a 1 : 1 : 1 : 1 ratio to four groups: systematic mental rehearsal (SMR) using MRI scans; SMR and three-dimensional (3D) virtual models; SMR and synthetic 3D printed models; and routine practice (control group). Surgeons operating on all but the control group underwent mental rehearsal with the visual aids, including axial MRI scans of the pelvis, interactive 3D virtual models reconstructed from axial MRIs, and synthetic models, manufactured by 3D printing. Operations were video-recorded and assessed by two experts blinded to allocation using two validated scores, the Competency Assessment Tool (CAT) and Objective Clinical Human Reliability Analysis (OCHRA). The primary outcome of the study was surgical performance, measured by the CAT. Results Forty-nine patients were randomized and allocated to the four groups. There were 12 participants in each of the control, MRI and SMR, and virtual and SMR groups, whereas the SMR using physical models and simulation group included 13. No difference was observed between groups in median CAT scores (control 30.50, MRI 34.25, virtual 31.75, physical 34.00; P = 0.748, partial η2 <0.001, where pη2 is indicative of effect size) or OCHRA scores (anterior, posterior, right and left lateral planes, transection P>0.200, pη2 =0.052–0.088). Time spent not performing dissection was significantly shorter for the SMR with MRI group than for the control (57.5 versus 42 respectively; P < 0.001, pη2 =0.212). Conclusion Mental rehearsal did not affect CAT and OCHRA scores of consultant surgeons. Reference number: ISRCTN 75603704 (https://www.isrctn.com).
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Affiliation(s)
- M Yiasemidou
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James’s University Hospital, Leeds, UK
- Academic Surgery, University of Hull, Hull, UK
| | - F Mushtaq
- School of Psychology, University of Leeds, Leeds, UK
| | - M Basheer
- Department of Colorectal Surgery, Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - R Galli
- Department of Colorectal Surgery, St James’s University Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - D Panagiotou
- General Surgery, York Teaching Hospital, York, UK
| | - S Stock
- General and Trauma Surgery, World Mate Emergency Hospital, Battambang, Cambodia
| | - N Preston
- School of Psychology, University of Leeds, Leeds, UK
| | | | - D G Jayne
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James’s University Hospital, Leeds, UK
- Department of Colorectal Surgery, St James’s University Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - D Miskovic
- Department of Colorectal Surgery, St Mark’s Hospital, Harrow, London, UK
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La Touche R, Sánchez-Vázquez M, Cuenca-Martínez F, Prieto-Aldana M, Paris-Alemany A, Navarro-Fernández G. Instruction Modes for Motor Control Skills Acquisition: A Randomized Controlled Trial. J Mot Behav 2019; 52:444-455. [PMID: 31359842 DOI: 10.1080/00222895.2019.1645087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The objective was to compare two different instruction modes used to teach patients with nonspecific chronic low back pain (CLBP) to perform a lumbar motor control task. The three intervention instruction modes used were: common verbal explanation of a motor task based on a motor control therapeutic exercise (MCTE-control group), MTCE instructed using motor imagery (MI) and MCTE instructed using tactile feedback (TF). The main outcome measure was lumbar motor control of the neutral position test. Forty-eight patients with CLBP were randomly allocated into three groups of 16 patients per group. The MI strategy was the most effective mode for developing the motor control task in an accurate and controlled manner, obtaining better outcomes than TF or verbal instruction.
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Affiliation(s)
- Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Macarena Sánchez-Vázquez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain
| | - Ferran Cuenca-Martínez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain
| | - María Prieto-Aldana
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain
| | - Alba Paris-Alemany
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Gonzalo Navarro-Fernández
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain
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Chen HE, Sonntag CC, Pepley DF, Prabhu RS, Han DC, Moore JZ, Miller SR. Looks can be deceiving: Gaze pattern differences between novices and experts during placement of central lines. Am J Surg 2018; 217:362-367. [PMID: 30514436 DOI: 10.1016/j.amjsurg.2018.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/02/2018] [Accepted: 11/12/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objective of this study was to determine whether gaze patterns could differentiate expertise during simulated ultrasound-guided Internal Jugular Central Venous Catheterization (US-IJCVC) and if expert gazes were different between simulators of varying functional and structural fidelity. METHODS A 2017 study compared eye gaze patterns of expert surgeons (n = 11), senior residents (n = 4), and novices (n = 7) during CVC needle insertions using the dynamic haptic robotic trainer (DHRT), a system which simulates US-IJCVC. Expert gaze patterns were also compared between a manikin and the DHRT. RESULTS Expert gaze patterns were consistent between the manikin and DHRT environments (p = 0.401). On the DHRT system, CVC experience significantly impacted the percent of time participants spent gazing at the ultrasound screen (p < 0.0005) and the needle and ultrasound probe (p < 0.0005). CONCLUSION Gaze patterns differentiate expertise during ultrasound-guided IJCVC placement and the fidelity of the simulator does not impact gaze patterns.
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Affiliation(s)
- Hong-En Chen
- Department of Industrial and Manufacturing Engineering, Penn State, University Park, PA, 16802, USA
| | - Cheyenne C Sonntag
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - David F Pepley
- Department of Mechanical and Nuclear Engineering, Penn State, University Park, PA, 16802, USA
| | - Rohan S Prabhu
- Department of Mechanical and Nuclear Engineering, Penn State, University Park, PA, 16802, USA
| | - David C Han
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, 17033, USA; Penn State Heart and Vascular Institute, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - Jason Z Moore
- Department of Mechanical and Nuclear Engineering, Penn State, University Park, PA, 16802, USA
| | - Scarlett R Miller
- Department of Industrial and Manufacturing Engineering, Penn State, University Park, PA, 16802, USA; School of Engineering Design, Technology, and Professional Programs, Penn State, University Park, PA, 16802, USA.
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De Witte B, Di Rienzo F, Martin X, Haixia Y, Collet C, Hoyek N. Implementing Cognitive Training Into a Surgical Skill Course: A Pilot Study on Laparoscopic Suturing and Knot Tying. Surg Innov 2018; 25:625-635. [PMID: 30222050 DOI: 10.1177/1553350618800148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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.
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Affiliation(s)
- Benjamin De Witte
- 1 University of Lyon, University Claude Bernard Lyon 1, Inter-University Laboratory of Human Movement Biology, Villeurbanne Cedex, France
| | - Franck Di Rienzo
- 1 University of Lyon, University Claude Bernard Lyon 1, Inter-University Laboratory of Human Movement Biology, Villeurbanne Cedex, France
| | - Xavier Martin
- 2 University of Lyon, University Claude Bernard Lyon 1, Faculty of Medicine, Surgery school, Lyon, France.,3 Service de Néphrologie, Transplantation et Immunologie Clinique, Hôpital Edouard Herriot, Hospices Civils de Lyon, France
| | - Ye Haixia
- 2 University of Lyon, University Claude Bernard Lyon 1, Faculty of Medicine, Surgery school, Lyon, France.,3 Service de Néphrologie, Transplantation et Immunologie Clinique, Hôpital Edouard Herriot, Hospices Civils de Lyon, France
| | - Christian Collet
- 1 University of Lyon, University Claude Bernard Lyon 1, Inter-University Laboratory of Human Movement Biology, Villeurbanne Cedex, France
| | - Nady Hoyek
- 1 University of Lyon, University Claude Bernard Lyon 1, Inter-University Laboratory of Human Movement Biology, Villeurbanne Cedex, France
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Sankaran NK, Chembrammel P, Siddiqui A, Snyder K, Kesavadas T. Design and Development of Surgeon Augmented Endovascular Robotic System. IEEE Trans Biomed Eng 2018; 65:2483-2493. [PMID: 29993507 DOI: 10.1109/tbme.2018.2800639] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Inadequate visual and force feedback while navigating surgical tools elevate the risk of endovascular procedures. It also poses occupational hazard due to repeated exposure to X-rays. A teleoperated robotic system that augments surgeon's actions is a solution. METHOD We have designed and developed an endovascular robotic system that augments surgeon's actions using conventional surgical tools, as well as generates feedback in order to ensure safety during the procedure. The reaction force from vasculature is estimated from motor current that drives the surgical tool. Calibration required for force estimation is based on bilevel optimization. Input shaping is used in conjunction with a cascaded controller to avoid large responses due to faster inputs and to track tool position. The design, realization, and testing of our system are presented. RESULTS The responses of the system in comparison with the dynamics model is similar vis-à-vis the same input commands. Any error in the position tracking is reduced by the cascaded controller. Phase-portrait analysis of the system showed that the system is stable. The reaction force estimation is validated against load cell measurements. The safety mechanism in the events of excessive reaction forces while interacting with vasculature is demonstrated. CONCLUSION AND SIGNIFICANCE Our system is a step toward intelligent robots that can assist surgeons during endovascular procedures by monitoring and alerting the surgeons regarding detrimental parameters. It arrests any unintended excursions of the surgical tools or surgeon's actions. This will also eliminate the need for surgeons to be in radiation environment.
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Davison S, Raison N, Khan MS, Dasgupta P, Ahmed K. Mental training in surgical education: a systematic review. ANZ J Surg 2017; 87:873-878. [PMID: 28851014 DOI: 10.1111/ans.14140] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/30/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pressures on surgical education from restricted working hours and increasing scrutiny of outcomes have been compounded by the development of highly technical surgical procedures requiring additional specialist training. Mental training (MT), the act of performing motor tasks in the 'mind's eye', offers the potential for training outside the operating room. However, the technique is yet to be formally incorporated in surgical curricula. This study aims to review the available literature to determine the role of MT in surgical education. METHODS EMBASE and Medline databases were searched. The primary outcome measure was surgical proficiency following training. Secondary analyses examined training duration, forms of MT and trainees level of experience. Study quality was assessed using Consolidated Standards of Reporting Trials scores or Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group. RESULTS Fourteen trials with 618 participants met the inclusion criteria, of which 11 were randomized and three longitudinal. Ten studies found MT to be beneficial. Mental rehearsal was the most commonly used form of training. No significant correlation was found between the length of MT and outcomes. MT benefitted expert surgeons more than medical students or novice surgeons. CONCLUSION The majority studies demonstrate MT to be beneficial in surgical education especially amongst more experienced surgeons within a well-structured MT programme. However, overall studies were low quality, lacked sufficient methodology and suffered from small sample sizes. For these reasons, further research is required to determine optimal role of MT as a supplementary educational tool within the surgical curriculum.
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Affiliation(s)
- Sara Davison
- MRC Centre for Transplantation, Division of Transplantation Immunology and Mucosal Biology, Faculty of Life Sciences and Medicine, King's College London, Guy's Hospital, London, UK
| | - Nicholas Raison
- MRC Centre for Transplantation, Division of Transplantation Immunology and Mucosal Biology, Faculty of Life Sciences and Medicine, King's College London, Guy's Hospital, London, UK
| | - Muhammad S Khan
- MRC Centre for Transplantation, Division of Transplantation Immunology and Mucosal Biology, Faculty of Life Sciences and Medicine, King's College London, Guy's Hospital, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Division of Transplantation Immunology and Mucosal Biology, Faculty of Life Sciences and Medicine, King's College London, Guy's Hospital, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Division of Transplantation Immunology and Mucosal Biology, Faculty of Life Sciences and Medicine, King's College London, Guy's Hospital, London, UK
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Yiasemidou M, Galli R, Glassman D, Tang M, Aziz R, Jayne D, Miskovic D. Patient-specific mental rehearsal with interactive visual aids: a path worth exploring? Surg Endosc 2017; 32:1165-1173. [PMID: 28840324 PMCID: PMC5807505 DOI: 10.1007/s00464-017-5788-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/28/2017] [Indexed: 11/06/2022]
Abstract
Background Surgeons of today are faced with unprecedented challenges; necessitating a novel approach to pre-operative preparation which takes into account the specific tests each case poses. In this study, we examine patient-specific mental rehearsal for pre-surgical practice and assess whether this method has an additional effect when compared to generic mental rehearsal. Methods Sixteen medical students were trained how to perform a simulated laparoscopic cholecystectomy (SLC). After baseline assessments, they were randomised to two equal groups and asked to complete three SLCs involving different anatomical variants. Prior to each procedure, Group A practiced mental rehearsal with the use of a pre-prepared checklist and Group B mental rehearsal with the checklist combined with virtual models matching the anatomical variations of the SLCs. The performance of the two groups was compared using simulator provided metrics and competency assessment tool (CAT) scoring by two blinded assessors. Results The participants performed equally well when presented with a “straight-forward” anatomy [Group A vs. Group B—time sec: 445.5 vs. 496 p = 0.64—NOM: 437 vs. 413 p = 0.88—PL cm: 1317 vs. 1059 p = 0.32—per: 0.5 vs. 0 p = 0.22—NCB: 0 vs. 0 p = 0.71—DVS: 0 vs. 0 p = 0.2]; however, Group B performed significantly better [Group A vs. B Total CAT score—Short Cystic Duct (SCD): 20.5 vs. 26.31 p = 0.02 η2 = 0.32—Double cystic Artery (DA): 24.75 vs. 30.5 p = 0.03 η2 = 0.28] and committed less errors (Damage to Vital Structures—DVS, SCD: 4 vs. 0 p = 0.03 η2=0.34, DA: 0 vs. 1 p = 0.02 η2 = 0.22). in the cases with more challenging anatomies. Conclusion These results suggest that patient-specific preparation with the combination of anatomical models and mental rehearsal may increase operative quality of complex procedures.
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Affiliation(s)
- Marina Yiasemidou
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
| | - Raffaele Galli
- John Goligher Surgery Unit, St. James University Hospital, Leeds, UK
| | | | | | - Rahoz Aziz
- Medical School, University of Leeds, Leeds, UK
| | - David Jayne
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Danilo Miskovic
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
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Yiasemidou M, Glassman D, Mushtaq F, Athanasiou C, Williams MM, Jayne D, Miskovic D. Mental practice with interactive 3D visual aids enhances surgical performance. Surg Endosc 2017; 31:4111-4117. [PMID: 28283764 PMCID: PMC5636856 DOI: 10.1007/s00464-017-5459-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 02/03/2017] [Indexed: 10/24/2022]
Abstract
BACKGROUND Evidence suggests that Mental Practice (MP) could be used to finesse surgical skills. However, MP is cognitively demanding and may be dependent on the ability of individuals to produce mental images. In this study, we hypothesised that the provision of interactive 3D visual aids during MP could facilitate surgical skill performance. METHODS 20 surgical trainees were case-matched to one of three different preparation methods prior to performing a simulated Laparoscopic Cholecystectomy (LC). Two intervention groups underwent a 25-minute MP session; one with interactive 3D visual aids depicting the relevant surgical anatomy (3D-MP group, n = 5) and one without (MP-Only, n = 5). A control group (n = 10) watched a didactic video of a real LC. Scores relating to technical performance and safety were recorded by a surgical simulator. RESULTS The Control group took longer to complete the procedure relative to the 3D&MP condition (p = .002). The number of movements was also statistically different across groups (p = .001), with the 3D&MP group making fewer movements relative to controls (p = .001). Likewise, the control group moved further in comparison to the 3D&MP condition and the MP-Only condition (p = .004). No reliable differences were observed for safety metrics. CONCLUSION These data provide evidence for the potential value of MP in improving performance. Furthermore, they suggest that 3D interactive visual aids during MP could potentially enhance performance, beyond the benefits of MP alone. These findings pave the way for future RCTs on surgical preparation and performance.
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Affiliation(s)
- Marina Yiasemidou
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James University Hospital, Clinical Science Building, Beckett street, Leeds, LS9 7TF, UK.
| | - Daniel Glassman
- School of Surgery, Health Education Yorkshire and the Humber, University of Leeds, Willow Terrace Road, Leeds, LS2 9JT, UK
| | - Faisal Mushtaq
- School of Psychology, Faculty of Medicine & Health, University of Leeds, Leeds, LS2 9JT, UK
| | - Christos Athanasiou
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James University Hospital, Clinical Science Building, Beckett street, Leeds, LS9 7TF, UK
| | - Mark-Mon Williams
- School of Psychology, Faculty of Medicine & Health, University of Leeds, Leeds, LS2 9JT, UK
| | - David Jayne
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James University Hospital, Clinical Science Building, Beckett street, Leeds, LS9 7TF, UK
| | - Danilo Miskovic
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, St James University Hospital, Clinical Science Building, Beckett street, Leeds, LS9 7TF, UK
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Anton NE, Bean EA, Hammonds SC, Stefanidis D. Application of Mental Skills Training in Surgery: A Review of Its Effectiveness and Proposed Next Steps. J Laparoendosc Adv Surg Tech A 2017; 27:459-469. [PMID: 28225325 DOI: 10.1089/lap.2016.0656] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Mental skills training, which refers to the teaching of performance enhancement and stress management psychological strategies, may benefit surgeons. Our objective was to review the application of mental skills training in surgery and contrast it to other domains, examine the effectiveness of this approach in enhancing surgical performance and reducing stress, and provide future directions for mental skills training in surgery. MATERIALS AND METHODS A systematic literature search of MEDLINE, PubMed, PsycINFO, and ClinicalKey was performed between 1996 and 2016. Keywords included were mental readiness, mental competency, mental skill, mental practice, imagery, mental imagery, mental rehearsal, stress management training, stress coping, mental training, performance enhancement, and surgery. Reviews of mental skills interventions in sport and well-regarded sport psychology textbooks were also reviewed. Primary outcome of interest was the effect of mental skills on surgical performance in the simulated or clinical environment. RESULTS Of 490 identified abstracts, 28 articles met inclusion criteria and were reviewed. The majority of the literature provides evidence that mental imagery and stress management training programs are effective at enhancing surgical performance and reducing stress. Studies from other disciplines suggest that comprehensive mental skills programs may be more effective than imagery and stress management techniques alone. CONCLUSIONS Given the demonstrated efficacy of mental imagery and stress management training in surgery and the incremental value of comprehensive mental skills curricula used in other domains, a concerted effort should be made to apply comprehensive mental skills curricula during surgical training.
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Affiliation(s)
- Nicholas E Anton
- 1 Department of Surgery, Indiana University School of Medicine , Indianapolis, Indiana
| | - Eric A Bean
- 2 Get a Strong Mind, Inc. , San Diego, California
| | - Samuel C Hammonds
- 3 Department of Orthopedics, Akron General Medical Center , Akron, Ohio
| | - Dimitrios Stefanidis
- 1 Department of Surgery, Indiana University School of Medicine , Indianapolis, Indiana
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Stefanidis D, Anton NE, Howley LD, Bean E, Yurco A, Pimentel ME, Davis CK. Effectiveness of a comprehensive mental skills curriculum in enhancing surgical performance: Results of a randomized controlled trial. Am J Surg 2017; 213:318-324. [PMID: 27908500 PMCID: PMC5303657 DOI: 10.1016/j.amjsurg.2016.10.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 10/07/2016] [Accepted: 10/20/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION We hypothesized that the implementation of a novel mental skills curriculum (MSC) during laparoscopic simulator training would improve mental skills and performance, and decrease stress. METHODS Sixty volunteer novices were randomized into intervention and control groups. All participants received FLS training while the intervention group also participated in the MSC. Skill transfer and retention were assessed on a live porcine model after training and 2 months later, respectively. Performance was assessed using the Test of Performance Strategies-2 (TOPS-2) for mental skills, FLS metrics for laparoscopic performance, and the State Trait Anxiety Inventory (STAI-6) and heart rate (HR) for stress. RESULTS Fifty-five participants (92%) completed training and the transfer test, and 46 (77%) the retention test. There were no significant differences between groups at baseline. Compared to controls the intervention group significantly improved their mental skill use, demonstrated higher laparoscopic skill improvement during retention, and reported less stress during the transfer test. CONCLUSIONS The MSC implemented in this study effectively enhanced participants' mental skill use, reduced cognitive stress in the operating room with a small impact on laparoscopic performance.
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Affiliation(s)
- Dimitrios Stefanidis
- Department of Surgery, Indiana University, Indianapolis, IN, United States; Carolinas Simulation Center, Carolinas HealthCare System, Charlotte, NC, United States.
| | - Nicholas E Anton
- Department of Surgery, Indiana University, Indianapolis, IN, United States; Carolinas Simulation Center, Carolinas HealthCare System, Charlotte, NC, United States
| | - Lisa D Howley
- Association of American Medical Colleges, Washington, DC, United States
| | - Eric Bean
- Get A Strong Mind, Inc, San Diego, CA, United States
| | - Ashley Yurco
- Carolinas Simulation Center, Carolinas HealthCare System, Charlotte, NC, United States
| | - Manuel E Pimentel
- Carolinas Simulation Center, Carolinas HealthCare System, Charlotte, NC, United States
| | - Cameron K Davis
- Carolinas Simulation Center, Carolinas HealthCare System, Charlotte, NC, United States
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Cordovani L, Cordovani D. A literature review on observational learning for medical motor skills and anesthesia teaching. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2016; 21:1113-1121. [PMID: 26506843 DOI: 10.1007/s10459-015-9646-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 10/21/2015] [Indexed: 06/05/2023]
Abstract
Motor skill practice is very important to improve performance of medical procedures and could be enhanced by observational practice. Observational learning could be particularly important in the medical field considering that patients' safety prevails over students' training. The mechanism of observational learning is based on the mirror neuron system, originally discovered in the monkey pre-motor cortex. Today we know that humans have a similar system, and its role is to understand and reproduce the observed actions of others. Many studies conclude that humans are able to plan and to make movements based on visual information by mapping a representation of observed actions, especially when the motor system is committed to do it. Moreover most researchers considered observational learning effective for complex skills, such as medical procedures. Additionally, observational learning could play a relevant role during anesthesia training since the learner works in pairs most of the time (dyad practice). Some teaching approaches should be taken into consideration: an implicit engagement of the observer motor system is required, immediate feedback seems to have an important effect, and a combination of observational and physical practice could be better than physical practice alone. In an environment where effectiveness and efficacy are essential, observational learning seems to fit well.
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Affiliation(s)
- Ligia Cordovani
- Master of Sciences in Health Sciences Education (in Progress), McMaster University, Hamilton, ON, Canada.
| | - Daniel Cordovani
- Anesthesia Department, McMaster University, Hamilton, ON, Canada
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Low-Fidelity Haptic Simulation Versus Mental Imagery Training for Epidural Anesthesia Technical Achievement in Novice Anesthesiology Residents: A Randomized Comparative Study. Anesth Analg 2016; 122:1516-23. [PMID: 27007077 DOI: 10.1213/ane.0000000000001260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND There are many teaching methods for epidural anesthesia skill acquisition. Previous work suggests that there is no difference in skill acquisition whether novice learners engage in low-fidelity (LF) versus high-fidelity haptic simulation for epidural anesthesia. No study, however, has compared the effect of LF haptic simulation for epidural anesthesia versus mental imagery (MI) training in which no physical practice is attempted. We tested the hypothesis that MI training is superior to LF haptic simulation training for epidural anesthesia skill acquisition. METHODS Twenty Post-Graduate Year 2 (PGY-2) anesthesiology residents were tested at the beginning of the training year. After a didactic lecture on epidural anesthesia, they were randomized into 2 groups. Group LF had LF simulation training for epidural anesthesia using a previously described banana simulation technique. Group MI had guided, scripted MI training in which they initially were oriented to the epidural kit components and epidural anesthesia was described stepwise in detail, followed by individual mental rehearsal; no physical practice was undertaken. Each resident then individually performed epidural anesthesia on a partial-human task trainer on 3 consecutive occasions under the direct observation of skilled evaluators who were blinded to group assignment. Technical achievement was assessed with the use of a modified validated skills checklist. Scores (0-21) and duration to task completion (minutes) were recorded. A linear mixed-effects model analysis was performed to determine the differences in scores and duration between groups and over time. RESULTS There was no statistical difference between the 2 groups for scores and duration to task completion. Both groups showed similarly significant increases (P = 0.0015) in scores over time (estimated mean score [SE]: group MI, 15.9 [0.55] to 17.4 [0.55] to 18.6 [0.55]; group LF, 16.2 [0.55] to 17.7 [0.55] to 18.9 [0.55]). Time to complete the procedure decreased similarly and significantly (P = 0.032) for both groups after the first attempt (estimated mean time [SE]: group MI, 16.0 [1.04] minutes to 13.7 [1.04] minutes to 13.3 [1.04] minutes; group LF: 15.8 [1.04] minutes to 13.4 [1.04] minutes to 13.1 [1.04] minutes). CONCLUSIONS MI is not different from LF simulation training for epidural anesthesia skill acquisition. Education in epidural anesthesia with structured didactics and continual MI training may suffice to prepare novice learners before an attempt on human subjects.
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Sattelmayer M, Elsig S, Hilfiker R, Baer G. A systematic review and meta-analysis of selected motor learning principles in physiotherapy and medical education. BMC MEDICAL EDUCATION 2016; 16:15. [PMID: 26768734 PMCID: PMC4714441 DOI: 10.1186/s12909-016-0538-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 01/07/2016] [Indexed: 05/19/2023]
Abstract
BACKGROUND Learning of procedural skills is an essential component in the education of future health professionals. There is little evidence on how procedural skills are best learnt and practiced in education. There is a need for educators to know what specific interventions could be used to increase learning of these skills. However, there is growing evidence from rehabilitation science, sport science and psychology that learning can be promoted with the application of motor learning principles. The aim of this review was to systematically evaluate the evidence for selected motor learning principles in physiotherapy and medical education. The selected principles were: whole or part practice, random or blocked practice, mental or no additional mental practice and terminal or concurrent feedback. METHODS CINAHL, Cochrane Central, Embase, Eric and Medline were systematically searched for eligible studies using pre-defined keywords. Included studies were evaluated on their risk of bias with the Cochrane Collaboration's risk of bias tool. RESULTS The search resulted in 740 records, following screening for relevance 15 randomised controlled trials including 695 participants were included in this systematic review. Most procedural skills in this review related to surgical procedures. Mental practice significantly improved performance on a post-acquisition test (SMD: 0.43, 95% CI 0.01 to 0.85). Terminal feedback significantly improved learning on a transfer test (SMD: 0.94, 95% CI 0.18 to 1.70). There were indications that whole practice had some advantages over part practice and random practice was superior to blocked practice on post-acquisition tests. All studies were evaluated as having a high risk of bias. Next to a possible performance bias in all included studies the method of sequence generation was often poorly reported. CONCLUSIONS There is some evidence to recommend the use of mental practice for procedural learning in medical education. There is limited evidence to conclude that terminal feedback is more effective than concurrent feedback on a transfer test. For the remaining parameters that were reviewed there was insufficient evidence to make definitive recommendations.
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Affiliation(s)
- Martin Sattelmayer
- Queen Margaret University, School of Health Sciences, Physiotherapy, Edinburgh, Scotland.
- University of Applied Sciences and Arts Western Switzerland Valais (HES-SO Valais-Wallis), School of Health Sciences, Leukerbad, Switzerland.
| | - Simone Elsig
- University of Applied Sciences and Arts Western Switzerland Valais (HES-SO Valais-Wallis), School of Health Sciences, Leukerbad, Switzerland.
| | - Roger Hilfiker
- University of Applied Sciences and Arts Western Switzerland Valais (HES-SO Valais-Wallis), School of Health Sciences, Leukerbad, Switzerland.
| | - Gillian Baer
- Queen Margaret University, School of Health Sciences, Physiotherapy, Edinburgh, Scotland.
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Beyond crisis resource management: new frontiers in human factors training for acute care medicine. Curr Opin Anaesthesiol 2014; 26:699-706. [PMID: 24113265 DOI: 10.1097/aco.0000000000000007] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW Error is ubiquitous in medicine, particularly during critical events and resuscitation. A significant proportion of adverse events can be attributed to inadequate team-based skills such as communication, leadership, situation awareness and resource utilization. Aviation-based crisis resource management (CRM) training using high-fidelity simulation has been proposed as a strategy to improve team behaviours. This review will address key considerations in CRM training and outline recommendations for the future of human factors education in healthcare. RECENT FINDINGS A critical examination of the current literature yields several important considerations to guide the development and implementation of effective simulation-based CRM training. These include defining a priori domain-specific objectives, creating an immersive environment that encourages deliberate practice and transfer-appropriate processing, and the importance of effective team debriefing. Building on research from high-risk industry, we suggest that traditional CRM training may be augmented with new training techniques that promote the development of shared mental models for team and task processes, address the effect of acute stress on team performance, and integrate strategies to improve clinical reasoning and the detection of cognitive errors. SUMMARY The evolution of CRM training involves a 'Triple Threat' approach that integrates mental model theory for team and task processes, training for stressful situations and metacognition and error theory towards a more comprehensive training paradigm, with roots in high-risk industry and cognitive psychology. Further research is required to evaluate the impact of this approach on patient-oriented outcomes.
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Moppett I, Sevdalis N. From pilots to Olympians: enhancing performance in anaesthesia through mental practice. Br J Anaesth 2013; 110:169-72. [PMID: 23319667 DOI: 10.1093/bja/aes472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Biron VL, Harris M, Kurien G, Campbell C, Lemelin P, Livy D, Côté DWJ, Ansari K. Teaching cricothyrotomy: a multisensory surgical education approach for final-year medical students. JOURNAL OF SURGICAL EDUCATION 2013; 70:248-53. [PMID: 23427972 DOI: 10.1016/j.jsurg.2012.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 11/05/2012] [Indexed: 05/26/2023]
Abstract
OBJECTIVE This study sought to evaluate the efficacy of a multisensory teaching approach in imparting the necessary knowledge, technical skills, and confidence to perform a cricothyrotomy to a cohort of fourth-year medical students. METHODS One hundred twenty students were recruited into the study. Subjects commenced by viewing an upper airway obstruction vodcast. Students subsequently observed an expert demonstration of cricothyrotomy on human cadavers. Following this, students were able to practice on cadaveric simulators guided by experts. The students' confidence was assessed with pre- and post-session confidence-level questionnaires. Thirty randomly selected students were then assessed with a post-session objective skill assessment test. Finally, a multiple choice examination was administered to test knowledge. RESULTS Ninety-five percent of student subjects achieved a score of at least 80% on the knowledge examination. All sampled students were considered competent to perform cricothyrotomy as judged by 2independent expert observers using the objective skill assessment test instrument. There was a statistically significant improvement between the pre- and post-CLQ scores (p<0.001). In keeping with current education theories on multisensory learning, qualitative feedback suggested a student preference for this teaching approach. CONCLUSION This study provides further evidence that a multisensory teaching intervention effectively improves the knowledge, skill, and confidence of fourth-year medical students in performing cricothyrotomy.
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Affiliation(s)
- Vincent L Biron
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Edmonton, University of Alberta, Alberta, Canada T6L 5X8
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Hayter M, Bould M, Afsari M, Riem N, Chiu M, Boet S. Does warm-up using mental practice improve crisis resource management performance? A simulation study †. Br J Anaesth 2013; 110:299-304. [DOI: 10.1093/bja/aes351] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Laschinger S, Medves J, Pulling C, McGraw DR, Waytuck B, Harrison MB, Gambeta K. Effectiveness of simulation on health profession students' knowledge, skills, confidence and satisfaction. INT J EVID-BASED HEA 2012; 6:278-302. [PMID: 21631826 DOI: 10.1111/j.1744-1609.2008.00108.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED Background Despite the recent wave of interest being shown in high-fidelity simulators, they do not represent a new concept in healthcare education. Simulators have been a part of clinical education since the 1950s. The growth of patient simulation as a core educational tool has been driven by a number of factors. Declining inpatient populations, concerns for patient safety and advances in learning theory are forcing healthcare educators to look for alternatives to the traditional clinical encounter for skill acquisition for students. Objective The aim of this review was to identify the best available evidence on the effectiveness of using simulated learning experiences in pre-licensure health profession education. Inclusion criteria Types of studies: This review considered any experimental or quasi-experimental studies that addressed the effectiveness of using simulated learning experiences in pre-licensure health profession practice. In the absence of randomised controlled trials, other research designs were considered for inclusion, such as, but not limited to: non-randomised controlled trials and before-and-after studies. TYPES OF PARTICIPANTS This review included participants who were pre-licensure practitioners in nursing, medicine, and rehabilitation therapy. Types of intervention(s)/phenomena of interest: Studies that evaluated the use of human physical anatomical models with or without computer support, including whole-body or part-body simulators were included. Types of outcome measures Student outcomes included knowledge acquisition, skill performance, learner satisfaction, critical thinking, self-confidence and role identity. Search strategy Using a defined search and retrieval method, the following databases were accessed for the period 1995-2006: Medline, CINAHL, Embase, PsycINFO, HealthSTAR, Cochrane Database of Systematic Reviews and ERIC. Methodological quality Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using the standardised critical appraisal instruments for evidence of effectiveness, developed by the Joanna Briggs Institute. Disagreements were dealt with by consultations with a third reviewer. Data collection Information was extracted from each paper independently by two reviewers using the standardised data extraction tool from the Joanna Briggs Institute. Disagreements were dealt with by consultation with a third reviewer. Data synthesis Due to the type of designs and quality of available studies, it was not possible to pool quantitative research study results in statistical meta-analysis. As statistical pooling was not possible, the findings are presented in descriptive narrative form. Results Twenty-three studies were selected for inclusion in this review including partial task trainers and high-fidelity human patient simulators. The results indicate that there is high learner satisfaction with using simulators to learn clinical skills. The studies demonstrated that human patient simulators which are used for teaching higher level skills, such as airway management, and physiological concepts are useful. While there are short-term gains in knowledge and skill performance, it is evident that performance of skills over time after initial training decline. Conclusion At best, simulation can be used as an adjunct for clinical practice, not a replacement for everyday practice. Students enjoyed the sessions and using the models purportedly makes learning easier. However, it remains unclear whether the skills learned through a simulation experience transfer into real-world settings. More research is needed to evaluate whether the skills acquired with this teaching methodology transfer to the practice setting such as the impact of simulation training on team function.
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Affiliation(s)
- Susan Laschinger
- School of Nursing, Queen's University, Kingston, Ontario, Canada, Emergency Medicine, Kingston General Hospital, Library Scientist, Director, Library Planning & Administration, Saskatchewan Provincial Library, Queen's Joanna Briggs Collaboration; a collaborating centre of the Joanna Briggs Institute, Queen's University, Kingston, Ontario, Canada
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Another Use of the Mobile Device: Warm-up for Laparoscopic Surgery. J Surg Res 2011; 170:185-8. [DOI: 10.1016/j.jss.2011.03.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 02/15/2011] [Accepted: 03/03/2011] [Indexed: 11/21/2022]
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Komesu Y, Urwitz-Lane R, Ozel B, Lukban J, Kahn M, Muir T, Fenner D, Rogers R. Does mental imagery prior to cystoscopy make a difference? A randomized controlled trial. Am J Obstet Gynecol 2009; 201:218.e1-9. [PMID: 19481728 PMCID: PMC3623945 DOI: 10.1016/j.ajog.2009.04.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 01/15/2009] [Accepted: 04/10/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We sought to determine whether mental imagery improves surgical performance of residents novice to cystoscopy. STUDY DESIGN We performed a multicenter randomized controlled trial. Residents who had performed < or = 3 cystoscopies were randomized to preoperative mental imagery sessions or reading a book chapter describing cystoscopy. The primary outcome was comparison of groups' surgical performance scores. Secondary outcomes were measurements of operative times and resident ratings of helpfulness of their preparation. Scores were compared using 2-factor analysis of variance. RESULTS In all, 68 residents were randomized; 33 to imagery and 35 to control groups. Groups did not differ in age, cystoscopic experience, residency level, or sex. The imagery group's surgical assessment scores were 15.9% higher than controls (P = .03). Operative times did not differ between groups. Imagery residents rated imagery preparation as more helpful than controls (P < .0001). CONCLUSION Residents considered mental imagery to be a more useful preoperative preparation. The mental imagery group's surgical performance was superior to controls.
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Affiliation(s)
- Yuko Komesu
- University of New Mexico Health Sciences Center Department of Obstetrics and Gynecology, Albuquerque, NM
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Karaoglu N. Being able to be a Don Quixote! A different way of teaching clinical skills. MEDICAL TEACHER 2009; 31:660-661. [PMID: 19811150 DOI: 10.1080/01421590903037744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Wang EE, Quinones J, Fitch MT, Dooley-Hash S, Griswold-Theodorson S, Medzon R, Korley F, Laack T, Robinett A, Clay L. Developing technical expertise in emergency medicine--the role of simulation in procedural skill acquisition. Acad Emerg Med 2008; 15:1046-57. [PMID: 18785939 DOI: 10.1111/j.1553-2712.2008.00218.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Developing technical expertise in medical procedures is an integral component of emergency medicine (EM) practice and training. This article is the work of an expert panel composed of members from the Society for Academic Emergency Medicine (SAEM) Interest Group, the SAEM Technology in Medical Education Committee, and opinions derived from the May 2008 Academic Emergency Medicine Consensus Conference, "The Science of Simulation in Healthcare." The writing group reviewed the simulation literature on procedures germane to EM training, virtual reality training, and instructional learning theory as it pertains to skill acquisition and procedural skills decay. The authors discuss the role of simulation in teaching technical expertise, identify training conditions that lead to effective learning, and provide recommendations for future foci of research.
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Affiliation(s)
- Ernest E Wang
- Division of Emergency Medicine, Evanston Northwestern Healthcare, Evanston, IL, USA.
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Effectiveness of simulation on health profession studentsʼ knowledge, skills, confidence and satisfaction. INT J EVID-BASED HEA 2008. [DOI: 10.1097/01258363-200809000-00002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sanders CW, Sadoski M, van Walsum K, Bramson R, Wiprud R, Fossum TW. Learning basic surgical skills with mental imagery: using the simulation centre in the mind. MEDICAL EDUCATION 2008; 42:607-612. [PMID: 18435713 DOI: 10.1111/j.1365-2923.2007.02964.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
CONTEXT Although surgeons and athletes frequently use mental imagery in preparing to perform, mental imagery has not been extensively researched as a learning technique in medical education. OBJECTIVE A mental imagery rehearsal technique was experimentally compared with textbook study to determine the effects of each on the learning of basic surgical skills. METHODS Sixty-four Year 2 medical students were randomly assigned to 2 treatment groups in which they undertook either mental imagery or textbook study. Both groups received the usual skills course of didactic lectures, demonstrations, physical practice with pigs' feet and a live animal laboratory. One group received additional training in mental imagery and the other group was given textbook study. Performance was assessed at 3 different time-points using a reliable rating scale. RESULTS Analysis of variance on student performance in live rabbit surgery revealed a significant interaction favouring the imagery group over the textbook study group. CONCLUSIONS The mental imagery technique appeared to transfer learning from practice to actual surgery better than textbook study.
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Affiliation(s)
- Charles W Sanders
- Scott & White Clinic, Texas A&M University Health Science Center, College of Medicine, Texas A&M College of Veterinary Medicine, Texas, USA.
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Building research capacity amongst kinesiologists: Results from a mixed methods study. Complement Ther Clin Pract 2008; 14:65-72. [DOI: 10.1016/j.ctcp.2006.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Accepted: 12/14/2006] [Indexed: 11/19/2022]
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Laschinger S, Medves J, Pulling C, McGraw R, Waytuck B, Harrison MB, Gambeta K. Effectiveness of simulation on health profession students' knowledge, skills, confidence and satisfaction. JBI LIBRARY OF SYSTEMATIC REVIEWS 2008; 6:265-309. [PMID: 27819835 DOI: 10.11124/01938924-200806070-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Despite the recent wave of interest being shown in high-fidelity simulators, they do not represent a new concept in healthcare education. Simulators have been a part of clinical education since the 1950s. The growth of patient simulation as a core educational tool has been driven by a number of factors. Declining inpatient populations, concerns for patient safety and advances in learning theory are forcing healthcare educators to look for alternatives to the traditional clinical encounter for skill acquisition for students. OBJECTIVE The aim of this review was to identify the best available evidence on the effectiveness of using simulated learning experiences in pre-licensure health profession education. INCLUSION CRITERIA Types of studies: This review considered any experimental or quasi-experimental studies that addressed the effectiveness of using simulated learning experiences in pre-licensure health profession practice. In the absence of randomised controlled trials, other research designs were considered for inclusion, such as, but not limited to: non-randomised controlled trials and before-and-after studies. TYPES OF PARTICIPANTS This review included participants who were pre-licensure practitioners in nursing, medicine, and rehabilitation therapy. Types of intervention(s)/phenomena of interest: Studies that evaluated the use of human physical anatomical models with or without computer support, including whole-body or part-body simulators were included. TYPES OF OUTCOME MEASURES Student outcomes included knowledge acquisition, skill performance, learner satisfaction, critical thinking, self-confidence and role identity. SEARCH STRATEGY Using a defined search and retrieval method, the following databases were accessed for the period 1995-2006: Medline, CINAHL, Embase, PsycINFO, HealthSTAR, Cochrane Database of Systematic Reviews and ERIC. METHODOLOGICAL QUALITY Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using the standardised critical appraisal instruments for evidence of effectiveness, developed by the Joanna Briggs Institute. Disagreements were dealt with by consultations with a third reviewer. DATA COLLECTION Information was extracted from each paper independently by two reviewers using the standardised data extraction tool from the Joanna Briggs Institute. Disagreements were dealt with by consultation with a third reviewer. DATA SYNTHESIS Due to the type of designs and quality of available studies, it was not possible to pool quantitative research study results in statistical meta-analysis. As statistical pooling was not possible, the findings are presented in descriptive narrative form. RESULTS Twenty-three studies were selected for inclusion in this review including partial task trainers and high-fidelity human patient simulators. The results indicate that there is high learner satisfaction with using simulators to learn clinical skills. The studies demonstrated that human patient simulators which are used for teaching higher level skills, such as airway management, and physiological concepts are useful. While there are short-term gains in knowledge and skill performance, it is evident that performance of skills over time after initial training decline. CONCLUSION At best, simulation can be used as an adjunct for clinical practice, not a replacement for everyday practice. Students enjoyed t he sessions and using the models purportedly makes learning easier. However, it remains unclear whether the skills learned through a simulation experience transfer into real-world settings. More research is needed to evaluate whether the skills acquired with this teaching methodology transfer to the practice setting such as the impact of simulation training on team function.
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Affiliation(s)
- Susan Laschinger
- 1. School of Nursing, Queen's University, Kingston, Ontario, Canada 2. Emergency Medicine, Kingston General Hospital 3. Library Scientist, Director, Library Planning & Administration, Saskatchewan Provincial Library 4. Queen's Joanna Briggs Collaboration; a collaborating centre of the Joanna Briggs Institute, Queen's University, Kingston, Ontario, Canada
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Rogers RG. Mental practice and acquisition of motor skills: examples from sports training and surgical education. Obstet Gynecol Clin North Am 2006; 33:297-304, ix. [PMID: 16647605 DOI: 10.1016/j.ogc.2006.02.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Learning surgical skills involves both fine and gross motor skills, and necessitates performance in stressful situations. This environment is similar to the environment in which an athlete performs. Mental imagery has been used successfully in training athletes of all levels of proficiency and enhances both motor skills and motivational skills of performing under stress. The literature of using mental imagery to train surgeons is limited to the teaching of simple surgical skills, but shows promise as another tool to teach technical skills.
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Affiliation(s)
- Rebecca G Rogers
- Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, MSC10 5580, ACC Fourth Floor, Albuquerque, NM 87131-0001, USA.
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