Mental Practice Enhances Surgical Technical Skills A Randomized Controlled Study
Mental Practice Enhances Surgical Technical Skills A Randomized Controlled Study
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DOI：
10.1097/sla.0b013e318207a789
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发表时间：
2011-02-01
影响因子：
9
通讯作者：
Darzi, Ara
中科院分区：
文献类型：
--
作者：
Arora, Sonal;Aggarwal, Rajesh;Darzi, Ara
目的：为了评估心理练习对手术性能的影响，背景：对患者安全的日益关注强调了手术室外替代培训策略的必要性。心理练习（MP），即“表演前对任务的认知排练”，在体育和音乐方面已经成功地提高了技能。本研究探讨MP是否提高性能在laparoscopic surgery.Methods：基线技能测试后，20名新手外科医生接受了培训，以证据为基础的虚拟现实课程。在使用封闭信封技术随机化后，所有参与者进行了5次虚拟现实（VR）腹腔镜胆囊切除术（LC）。心理练习参与者在每次LC之前进行30分钟的MP;对照组参与者观看在线讲座。使用基于技术技能的视频客观结构化评估全球评级量表（评分从7分到35分）评估技术性能。心理意象进行了评估，使用先前验证的心理意象Questionnaire.Results：18名参与者完成了这项研究。基线技术能力无组间差异。MP组和对照组均显示了学习曲线。心理练习上级对照（全球评级）（中位数20 vs 15，P = 0.005），第二次LC第三次LC（24 vs 15.5，P <0.001）、第四次LC（25.5 vs 15.5，P <0.001）和第五次LC（27.5 vs 19.5，P = 0.00）。MP组在所有阶段的图像也显著上级对照组（P < 0.05）。改善的图像与更好的性能质量显著相关（rho 0.51-0.62，Ps < 0.05）。结论：这是第一个随机对照研究，表明MP提高了基于VR腹腔镜胆囊切除术的性能质量。这可能是一个时间和成本效益的策略，以加强传统的培训，从而有可能改善病人的护理。
Objective: To assess the effects of mental practice on surgical performance.Background: Increasing concerns for patient safety have highlighted a need for alternative training strategies outside the operating room. Mental practice (MP), "the cognitive rehearsal of a task before performance," has been successful in sport and music to enhance skill. This study investigates whether MP enhances performance in laparoscopic surgery.Methods: 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.Results: 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 (rho 0.51-0.62, Ps < 0.05).Conclusions: 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.