Adapting Motor Imagery Training Protocols to Surgical Education: A Systematic Review and Meta-Analysis

Enhancing motor imagery practice using synchronous action observation

In this paper, we discuss a variety of ways in which practising motor actions by means of motor imagery (MI) can be enhanced via synchronous action observation (AO), that is, by AO + MI. We review the available research on the (mostly facilitatory) behavioural effects of AO + MI practice in the early stages of skill acquisition, discuss possible theoretical explanations, and consider several issues related to the choice and presentation schedules of suitable models. We then discuss considerations related to AO + MI practice at advanced skill levels, including expertise effects, practical recommendations such as focussing attention on specific aspects of the observed action, using just-ahead models, and possible effects of the perspective in which the observed action is presented. In section "Coordinative AO + MI", we consider scenarios where the observer imagines performing an action that complements or responds to the observed action, as a promising and yet under-researched application of AO + MI training. In section "The dual action simulation hypothesis of AO + MI", we review the neurocognitive hypothesis that AO + MI practice involves two parallel action simulations, and we consider opportunities for future research based on recent neuroimaging work on parallel motor representations. In section "AO + MI training in motor rehabilitation", we review applications of AO, MI, and AO + MI training in the field of neurorehabilitation. Taken together, this evidence-based, exploratory review opens a variety of avenues for future research and applications of AO + MI practice, highlighting several clear advantages over the approaches of purely AO- or MI-based practice.

Impact of a digital training platform and tailored education on the chest image interpretation performance of healthcare professionals

INTRODUCTION

With the use of expert consensus a digital training tool was developed which proved useful when teaching radiographers how to interpret chest images. The training tool included A) a search strategy and B) an educational video programme to communicate the search strategies using eye tracking technology.

METHODS

A multi-reader multi-case study was undertaken to assess the effectiveness of a training tool and study day. The interventions were designed to cover a range of potential pathological presentations. Participants, physiotherapists and nurse practitioners working at a cardiothoracic Intensive Care Unit (ICU), were asked to interpret 20 chest images at the beginning of the study and following access to each intervention. Participants received access to the training tool at different times for a period of 4-6 weeks. A study day was then be provided to all participants and interpretations of a different dataset were completed by all. Each participant was asked to complete a questionnaire to gain perceptions of the training provided.

RESULTS

Twenty-eight participants interpreted a total of 1680 chest radiographs. Improvements in specificity were noted across the participants. Sensitivity fell in both groups following both training interventions.

CONCLUSION

Face to face learning and digital components are potentially useful in professional development and revision in chest x-ray interpretation for non-medical healthcare professionals working in an ICU setting.

IMPLICATIONS FOR PRACTICE

The training tool and study day may be useful as image interpretation revision aids or to accompany formal methods of education.

Inequivalent and uncorrelated response priming in motor imagery and execution

Introduction

Theoretical considerations on motor imagery and motor execution have long been dominated by the functional equivalence view. Previous empirical works comparing these two modes of actions, however, have largely relied on subjective judgments on the imagery process, which may be exposed to various biases. The current study aims to re-examine the commonality and distinguishable aspects of motor imagery and execution via a response repetition paradigm. This framework aims to offer an alternative approach devoid of self-reporting, opening the opportunity for less subjective evaluation of the disparities and correlations between motor imagery and motor execution.

Methods

Participants performed manual speeded-choice on prime-probe pairs in each trial under three conditions distinguished by the modes of response on the prime: mere observation (Perceptual), imagining response (Imagery), and actual responses (Execution). Responses to the following probe were all actual execution of button press. While Experiment 1 compared the basic repetition effects in the three prime conditions, Experiment 2 extended the prime duration to enhance the quality of MI and monitored electromyography (EMG) for excluding prime imagery with muscle activities to enhance specificity of the underlying mechanism.

Results

In Experiment 1, there was no significant repetition effect after mere observation. However, significant repetition effects were observed in both imagery and execution conditions, respectively, which were also significantly correlated. In Experiment 2, trials with excessive EMG activities were excluded before further statistical analysis. A consistent repetition effect pattern in both Imagery and Execution but not the Perception condition. Now the correlation between Imagery and Execution conditions were not significant.

Conclusion

Findings from the current study provide a novel application of a classical paradigm, aiming to minimize the subjectivity inherent in imagery assessments while examining the relationship between motor imagery and motor execution. By highlighting differences and the absence of correlation in repetition effects, the study challenges the functional equivalence hypothesis of imagery and execution. Motor representations of imagery and execution, when measured without subjective judgments, appear to be more distinguishable than traditionally thought. Future studies may examine the neural underpinnings of the response repetition paradigm to further elucidating the common and separable aspects of these two modes of action.

How I Do It: Structured Narration for Cognitive Simulation-based Training in Robotic Surgery

Video in robotic surgical education is an important and effective training tool. The educational benefit of video training tools can be enhanced by incorporating cognitive simulation using mental imagery. Narration of robotic surgical training video is an under-explored aspect of video design. Narration can be structured to stimulate visualization and procedural mental mapping. To achieve this, narration should be constructed to follow operative phases and steps and include the procedural, technical and cognitive components. This approach provides a foundation for building an understanding of the key concepts required to safely complete a procedure.

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.

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.

Motor imagery in congenital hemiplegia: Impairments are not universal

BACKGROUND

Motor imagery (MI) training may benefit children with congenital hemiplegia, but reports on MI ability are mixed. This study considered individual patterns of performance to better understand MI ability in children with hemiplegia.

METHOD

Twenty children with hemiplegia (7-13 years; 10 with right hemiplegia), completed a MI task, IQ estimate and functional tests. Children with hemiplegia scoring above chance on the MI task were compared to a group of age-matched peers. The performance patterns of those scoring below chance were considered individually.

RESULTS

Three children with right hemiplegia were excluded due to low IQ. Seven of 10 children with left hemiplegia and three of seven with right hemiplegia performed MI at an equivalent level to peers without hemiplegia. The seven children with hemiplegia who scored significantly below chance scored lower on functional tests, but differences here failed to reach an adjusted significance level. Four of the seven appeared engaged in MI, but performed very poorly. The remaining three had unique performance patterns explored in more detail.

CONCLUSION

Motor imagery deficits are not universally observed in children with congenital hemiplegia and individual performance should be examined before completing group analyses. Recommendations for exclusions and reporting in future studies are made.