Mental Skills Training and Resident Surgical Outcomes: A Systematic Review

Training in Aortic Arch Surgery as a Blueprint for a Structured Educational Team Approach: A Review

Background and objectives: The treatment of pathologies of the aortic arch is a complex field of cardiovascular surgery that has witnessed enormous progress recently. Such treatment is mainly performed in high-volume centres, and surgeons gain great experience in mastering potential difficulties even under emergency circumstances, thereby ensuring the effective therapy of more complex pathologies with lower complication rates. As the numbers of patients rise, so does the need for well-trained surgeons in aortic arch surgery. But how is it possible to learn surgical procedures in a responsible way that, in addition to surgical techniques, also places particular demands on the overall surgical management such as perfusion strategy and neuro-protection? This is why a good training programme teaching young surgeons without increasing the risk for patients is indispensable. Our intention was to highlight the most challenging aspects of aortic arch surgery teaching and how young surgeons can master them. Materials and Methods: We analysed the literature to find out which methods are most suitable for such teaching goals and what result they reveal when serving as teaching procedures. Results: Several studies were found comparing the surgical outcome of young trainees with that of specialists. It was found that the results were comparable whether the procedure was performed by a specialist or by a trainee assisted by the specialist. Conclusions: We thus came to the conclusion that even for such a complex type of intervention, the responsible training of young surgeons by experienced specialists is possible. However, it requires a clear strategy and team approach to ensure a safe outcome for the patient.

Guided, motor, and mental imagery adjuncts to teaching central venous access

Background

Mental, motor, and guided imagery techniques are commonly used in sports psychology, but less often in medical education. Utilization of imagery-based techniques (IBTs) in combination with traditional teaching methods may provide a low-cost, innovative approach to improving outcomes in graduate medical education.

Objective

The objective was to assess whether medical students demonstrate greater proficiency in the ability to obtain central venous access in simulation trainers following exposure to guided, mental, and motor imagery teaching methods in comparison to traditional methods.

Methods

Volunteer fourth-year medical students during their emergency medicine rotation were randomly assigned to two groups, traditional plus imagery teaching or traditional teaching alone. The control group watched a video tutorial on central line placement methods. The study group watched the same video with the addition of imagery components. Participants filled out survey questions before and after the video and again after line placement. Proctors blinded to student group assignments then observed student placement of an internal jugular triple-lumen catheter on a simulation trainer and completed a standardized performance rubric.

Results

Sixty medical students participated. Two were excluded for having performed five or more lines either clinically or in a previous simulation. There was no difference in self-perceived competence in line placement prior to watching the video or in the number of lines previously performed between groups. The imagery group (n = 25) averaged 1.3 errors/need for intervention compared to 2.2 errors/need for intervention in the control group (n = 33; p = 0.045, 95% confidence interval [CI] 0.02 to 1.61). Time to place the line was similar-8.9 min for the control group versus 8.6 min for the imagery group (p = 0.74, 95% CI -1.39 to 1.95).

Conclusions

The use of IBTs may be a promising adjunct to traditional medical teaching of procedures in emergency medicine.

Mental practice for laparoscopic salpingectomy

Mental practice (MP) is a method of enhancing surgical training by rehearsal of a task without physical action. The primary objective of the study was to develop and validate a MP tool for laparoscopic salpingectomy (LS). An imagery script for LS was developed and used to facilitate a structured MP session for trainees in Obstetrics and Gynaecology and expert gynaecologists across three teaching hospitals in the UK. A virtual platform was used for one trainee group to assess its feasibility compared to a face-to-face approach. Pre- and post-session assessments were conducted to evaluate the impact of the script on motivation, confidence, preparedness and quality of imagery and demonstrated a significant improvement in global imagery scores for both novice groups. The expert group scored significantly higher than the face-to-face novice group on all items both before and after MP, indicating construct validity. There were no significant differences demonstrated between the two novice groups, thus demonstrating the virtual platform to be a non-inferior approach - an important consideration in the current COVID era.

The My Strengths Training for Life™ program: Rationale, logic model, and description of a strengths-based intervention for young people experiencing homelessness

Traditionally, UK housing services have focused on providing temporary accommodation, identifying risk factors, and preventing negative outcomes to young people experiencing homelessness. However, deficit approaches may lead young people to becoming dependent on services and face greater marginalization and stigmatization. Meeting long-standing calls to focus more on young people's positive attributes and abilities, the My Strengths Training for Life™ (MST4Life™) program was developed as a community partnership with a large housing service. This paper describes the rationale, logic model, and content of the MST4Life™ program using the TIDieR (Template for Intervention Description and Replication) checklist. MST4Life™ is a strengths-based and experiential psychoeducation intervention for young people aged 16-24 years who are homeless or at risk. Grounded in positive youth development and basic psychological needs theory, its aim is to provide meaningful opportunities for participants to recognize, use, and further develop their mental skills and strengths. In turn, enhancing intentional self-regulation is expected to improve physical, mental, and social health and wellbeing, and support positive transitions to independent living. The potential long-term impacts include a reduction in the number of young people returning as homeless, lower rates of mental illness and mortality, and a cost saving to the public purse.

Applying sport psychology in health professions education: A systematic review of performance mental skills training

INTRODUCTION

Health professionals are expected to consistently perform to a high standard during a variety of challenging clinical situations, which can provoke stress and impair their performance. There is increasing interest in applying sport psychology training using performance mental skills (PMS) immediately before and during performance.

METHODS

A systematic review of the main relevant databases was conducted with the aim to identify how PMS training (PMST) has been applied in health professions education and its outcomes.

RESULTS

The 20 selected studies noted the potential for PMST to improve performance, especially for simulated situations. The key implementation components were a multimodal approach that targeted several PMS in combination and delivered face-to-face delivery in a group by a trainer with expertise in PMS. The average number of sessions was 5 and of 57 min duration, with structured learner guidance, an opportunity for practice of the PMS and a focus on application for transfer to another context.

CONCLUSION

Future PMST can be informed by the key implementation components identified in the review but further design and development research is essential to close the gap in current understanding of the effectiveness of PMST and its key implementation components, especially in real-life situations.

Impact of mental imagery on enhancing surgical skills learning in novice's surgeons: a pilot study

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.

Surgical cognitive simulation improves real-world surgical performance: randomized study

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.

Mental rehearsal: A useful simulation adjunct to surgical training

BACKGROUND

Simulation is an effective adjunct to surgical training. There is increasing interest in the use of mental rehearsal as a form of cognitive simulation. The mental visualisation of a motor skill is recognised to enhance performance; a concept not novel to surgeons. Despite this, mental rehearsal has yet to be formally incorporated into surgical training. This study aims to assess the use of mental rehearsal amongst general surgical trainees and consultants.

METHOD

A six-item questionnaire was designed and electronically circulated to general surgical core trainees, registrars, fellows and consultants. Qualitative and quantitative analysis was independently performed.

RESULTS

153 responses (consultants = 51.6%, trainees = 48.4%) were received over 3 weeks. 91.5% of surgeons mentally rehearse prior to operating. Its use predominates for complex cases only. There is no difference in case complexity and the surgeon's grade in regard to when mental rehearsal is performed (χ² = 1.027, p = 0.31). Individual mental rehearsal is preferred. Consultants are more likely to mentally rehearse with others, although there was no statistical difference compared to trainees (χ² = 0.239, p = 0.63). Clarification, confidence and anticipation of potential difficulties were the perceived benefits of mental rehearsal reported in 58.6% of responses.

CONCLUSIONS

Mental rehearsal prior to operating appears instinctive for general surgeons irrespective of seniority and case complexity. Whether the efficacy of mental rehearsal on training is sustained and continues as surgeons progress along the training curve are unknown. Alternative methods of surgical training are very much needed. We propose mental rehearsal.