Development of a simulation-based mental skills curriculum for surgeons

描述(由申请人提供)：外科医生在手术室经常面临压力大的情况，这可能会对他们的表现产生负面影响。过多的压力已被证明会对技术和非技术性能产生负面影响，并增加出错的可能性，潜在地危及患者的安全。较差的处理压力情况的能力也被证明阻碍了模拟器获得的技能转移到手术室(OR)。不幸的是，提高成绩和应对压力的策略并不是外科训练的一部分，尽管它们已经被证明在压力条件下最大限度地发挥性能是有效的，并且在其他学科中经常使用，比如军队或表现最好的运动员。 这个项目的目标是开发一个新颖的，自给自足的心理技能课程(MSC)， 将为学习者提供在具有挑战性的临床情况下取得优异表现所需的关键表现--增强和压力--应对策略。我们假设，在外科实习生的标准技能课程中增加心理技能培训将使应激条件下的表现恶化最小化，促进技能的获得和向临床领域的转移，并增加对模拟器习得的外科技能的保留。 该项目的具体目标是创建一个易于广泛实施的现成MSC，展示其在不同水平的学习者经验和学科的压力条件下将技术和非技术性能恶化降至最低的有效性，调查其对外科技能获得和保留的影响，确定哪些学习者从心理技能培训中受益最大，并评估其对患者预后的影响。 为了检验假设和实现这个项目的具体目标，这个项目是一个为期三年的多专业项目 提出了本文的研究方向。在第一年，MSC将在专家表演的帮助下发展 心理学家和飞行员对不同学习者的便利样本进行了测试，以获得初步数据和反馈，从而使课程优化。第二年，将通过随机将初学者(学生)分配到对照组和MSC训练组来测试MSC的有效性，并在基于熟练程度的模拟器培训后评估他们在活体动物OR模型中的技能转移和保持。预期MSC组将实现比控制组更高的性能和更少的错误。第三年，普通外科和妇科住院医生也将被随机分配到对照组和MSC组，并接受熟练掌握FLS模块的培训。然后，他们的表现将在动物或在常规和应激条件下和在人类OR中进行比较，并将评估患者的结果。我们的期望再次是，MSC组在所有测量的参数上都将优于对照组。 如果拟议的研究支持其假设，研究结果可能会对我们在模拟器上培训学习者的方式产生重大影响，最终对学习者、患者安全和临床结果都有好处。此外，本课程将作为AHRQ患者安全网络(PSNet)的资源提供，并作为同行评议资源在美国医学院协会(AAMC)MedEdPORTAL中提交以供广泛实施。

DESCRIPTION (provided by applicant): Surgeons are often faced with stressful situations in the operating room that may negatively affect their performance. Excessive stress has been demonstrated to negatively impact technical and nontechnical performance and increase the likelihood of errors potentially compromising patient safety. Poor ability to deal with stressful situations has also been shown to impede the transfer of simulator--acquired skill to the operating room (OR). Unfortunately, performance--enhancement and stress--coping strategies are not part of surgical training even though they have been shown to be effective at maximizing performance under stressful conditions and are practiced routinely in other disciplines such as the military or for top performing athletes. The goal of this project is to develop a novel, self--contained mental skills curriculum (MSC) that will provide learners with key performance--enhancement and stress--coping strategies needed to achieve superior performance during challenging clinical situations. We hypothesize that the addition of mental skills training to the standard skills curriculum of surgical trainees will minimize performance deterioration under stressful conditions, enhance the skill acquisition and transfer to the clinical arena, and increase retention of simulator--acquired surgical skill. The specific aims of the project are to create an off-the--shelf MSC that can be easily implemented widely, demonstrate its effectiveness in minimizing technical and nontechnical performance deterioration under stressful conditions across levels of learner experience and disciplines, investigate its impact on surgical skill acquisition and retention, identify which learners benefit most from mental skills training, and assess its impact on patient outcomes. To test the hypothesis and achieve the specific aims of this project, a three year multi--specialty study is proposed. During the first year, the MSC will be developed with the help of an expert performance psychologist and pilot tested on a convenience sample of diverse learners to obtain preliminary data and feedback that will allow curriculum optimization. The second year, the effectiveness of the MSC will be tested by randomly assigning novice learners (students) to a control group and a MSC training group and assessing their skill transfer and retention in a live animal OR model after proficiency--based simulator training on the Fundamentals of Laparoscopic Surgery (FLS) modules. The expectation is that the MSC group will achieve higher performance and commit fewer errors than the control group. The third year, general surgery and gynecology residents will also be randomly assigned to a control and a MSC group and train to proficiency on the FLS modules. Their performance will then be compared in the animal OR under regular and stressful conditions and in the human OR, and patient outcomes will be assessed. The expectation is again that the MSC group will outperform the control group in all measured parameters. If the proposed study provides support for its hypothesis, the findings can have a major impact on the way we train learners on simulators, with ultimate benefits for learners, patient safety, and clinical outcomes. In addition, this curriculum will be available as a resource within AHRQ's Patient Safety Network (PSNet) and submitted as a peer reviewed resource within the Association of American Medical Colleges (AAMC) MedEdPORTAL for wide implementation.