Mental Practice: Effective Stress Management Training for Novice Surgeons
Mental Practice: Effective Stress Management Training for Novice Surgeons
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DOI：
10.1016/j.jamcollsurg.2010.09.025
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发表时间：
2011-02-01
影响因子：
5.2
通讯作者：
Sevdalis, Nick
中科院分区：
文献类型：
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作者：
Arora, Sonal;Aggarwal, Rajesh;Sevdalis, Nick
背景：外科医生经常受到过度的急性应激，这会损害他们的表现。心理练习（MP）是其他高绩效行业用于缓解焦虑的策略。本研究调查，如果MP减少压力，在新手surgics.Study设计：一个前瞻性的，随机对照设计，随机抽样招募20名新手外科医生。在基线测试后，参与者接受了基于证据的虚拟现实（VR）课程的培训。然后，他们在随机分配到MP组或对照组后进行了5例VR腹腔镜胆囊切除术（LC）。MP组在每次LC前使用经验证的MP训练方案进行30分钟的MP;对照组参与者进行不相关的活动。主观上使用经验证的状态-特质认知量表（STAI）问卷进行压力评估，客观上使用连续心率（HR）监测仪和唾液皮质醇进行压力评估。使用经过验证的心理意象问卷对心理意象进行评估。结果：十八名参与者完成了研究。在基线压力、想象力或技术能力方面没有组间差异。与对照组相比，MP组的主观压力（STAI）较低（中位数8.40 vs 11.31，p < 0.01）。MP组在平均HR（中位数72 vs 88次/分钟，p < 0.0001）、最大HR（中位数102 vs 119次/分钟，p < 0.01）和皮质醇（中位数2.26 vs 3.85 nmol/L，p < 0.05）方面的客观压力也显著降低。压力和意象之间存在显著的负相关性，表明改善的意象与较低的压力相关（p < 0.05）。结论：短时间的MP降低了VR模拟器上对压力的主观、心血管和神经内分泌反应。进一步的研究应该确定这种影响是否超出了新手外科医生的范围，并转移到手术室。（美国科尔外科杂志2011;212：225-233。(C)2011年美国外科医生学会）
BACKGROUND: Surgeons are often subject to excessive levels of acute stress that can impair their performance. Mental practice (MP) is a strategy used in other high-performance industries to alleviate anxiety. This study investigated if MP reduces stress in novice surgeons.STUDY DESIGN: A prospective, randomized controlled design was used with 20 novice surgeons recruited by random sampling. After baseline testing, participants underwent training on an evidence-based virtual reality (VR) curriculum. They then performed 5 VR laparoscopic cholecystectomies (LC) after being randomized to MP or control groups. The MP group performed 30 minutes of MP using a validated MP training protocol before each LC; control participants conducted an unrelated activity. Stress was assessed subjectively using the validated State-Trait Anxiety-Inventory (STAI) questionnaire and objectively with a continuous heart rate (HR) monitor and salivary cortisol. Mental imagery was assessed using the validated mental imagery questionnaire.RESULTS: Eighteen participants completed the study. There were no intergroup differences in baseline stress, imagery, or technical ability. Comparing the MP group with controls, subjective stress (STAI) was lower for the MP group (median 8.40 vs 11.31, p < 0.01). Objective stress was also significantly reduced for the MP group in terms of the average HR (median 72 vs 88 beats/minute, p < 0.0001), maximum HR (median 102 vs 119 beats/minute, p < 0.01), and cortisol (median 2.26 vs 3.85 nmol/L, p < 0.05). Significant negative correlations were obtained between stress and imagery, indicating that improved imagery was associated with lower stress (p < 0.05).CONCLUSIONS: A short period of MP reduces the subjective, cardiovascular, and neuroendocrine response to stress on a VR simulator. Additional research should determine whether this effect extends beyond novice surgeons and transfers to the operating room. (J Am Coll Surg 2011;212: 225-233. (C) 2011 by the American College of Surgeons)