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Mental Rehearsal Enhances Acquisition of Surgical Skills

13 Jun

Researchers from Imperial College London and St. Mary's Hospital in London investigated the effects of “mental practice” (guided imagery) on surgical performance.  Mental practice (imaginal rehearsal or guided imagery) of a task before performance has been shown to be successful at enhancing skill with sports and music [Ed. Note: also with rehab and several medical procedures]. This study looks at its impact on laparoscopic surgery.  The idea is to give novice surgeons ample opportunity to practice safely before operating on an actual patient.

After baseline skills testing, 20 novice surgeons underwent training on an evidence-based virtual reality curriculum. After randomization using the closed envelope technique, all participants performed 5 Virtual Reality (VR) laparoscopic cholecystectomies (LC).  Mental practice participants performed 30 minutes of MP before each LC; control participants viewed an online lecture.
Technical performance was assessed using video Objective Structured Assessment of Technical Skills-based global ratings scale (scored from 7 to 35). Mental imagery was assessed using a previously validated Mental Imagery Questionnaire.

Eighteen participants completed the study. There were no intergroup differences in baseline technical ability. Learning curves were demonstrated for both MP and control groups. Mental practice was superior to control (global ratings) for the first LC (median 20 vs 15, P = 0.005), second LC (20.5 vs 13.5, P = 0.001), third LC (24 vs 15.5, P < 0.001), fourth LC (25.5 vs 15.5, P < 0.001) and the fifth LC (27.5 vs 19.5, P = 0.00). The imagery for the MP group was also significantly superior to the control group across all sessions (P < 0.05). Improved imagery significantly correlated with better quality of performance (ρ 0.51–0.62, Ps < 0.05).

This is the first randomized controlled study to show that MP enhances the quality of performance based on VR laparoscopic cholecystectomy. This may be a time- and cost-effective strategy to augment traditional training in the OR thus potentially improving patient care.

Citation: Arora S, Aggarwal R, Sirimanna P, Moran A, Grantcharov T, Kneebone R, Sevdalis N, Darzi A. Mental practice enhances surgical technical skills: a randomized controlled study. Annals of Surgery. 2011 Feb;253 (2): pp. 265-70. This email address is being protected from spambots. You need JavaScript enabled to view it.

Belleruth Naparstek

Psychotherapist, author and guided imagery pioneer Belleruth Naparstek is the creator of the popular Health Journeys guided imagery audio series. Her latest book on imagery and posttraumatic stress, Invisible Heroes: Survivors of Trauma and How They Heal (Bantam Dell), won the Spirituality & Health Top 50 Books Award