Development of a simulation-based mental skills curriculum for surgeons

描述（由申请人提供）：外科医生在手术室中经常面临可能对其表现产生负面影响的压力情况。已证明过度压力会对技术和非技术性能产生负面影响，并增加可能危及患者安全的错误的可能性。处理压力情况的能力差也被证明会阻碍将模拟器获得的技能转移到手术室（OR）。不幸的是，表现-增强和压力-应对策略并不是手术训练的一部分，尽管它们已被证明在压力条件下有效地最大限度地提高表现，并且在其他学科中经常练习，如军事或顶级运动员。 这个项目的目标是开发一个新颖的，独立的心理技能课程（MSC）， 将为学习者提供关键的表现--增强和压力--应对策略，这些策略是在具有挑战性的临床情况下实现上级表现所必需的。我们假设，除了心理技能训练的标准技能课程的外科实习生将尽量减少性能恶化的压力条件下，提高技能的收购和转移到临床竞技场，并增加保留模拟器-收购的手术技能。 该项目的具体目标是创建一个现成的MSC，可以很容易地广泛实施，证明其有效性，最大限度地减少技术和非技术性能恶化的压力条件下，各级学习者的经验和学科，调查其对手术技能的获取和保留的影响，确定哪些学习者受益最多的心理技能培训，并评估其对患者的影响结果。 为了验证这一假设并实现本项目的具体目标， 研究提出。在第一年，MSC将在专家的帮助下开发。 心理学家和飞行员对不同学习者的便利样本进行测试，以获得初步数据和反馈，从而优化课程。第二年，MSC的有效性将通过随机分配新手学习者（学生）到对照组和MSC培训组进行测试，并在腹腔镜手术（FLS）模块基础上进行基于熟练度的模拟器培训后，评估他们在活体动物OR模型中的技能转移和保留。期望的是MSC组将实现比控制组更高的性能并且犯更少的错误。第三年，普通外科和妇科住院医师也将被随机分配到对照组和MSC组，并接受FLS模块的熟练程度培训。然后将在动物OR中在常规和压力条件下以及在人类OR中比较它们的性能，并评估患者结局。预期MSC组在所有测量参数方面的表现将再次优于对照组。 如果拟议的研究为其假设提供了支持，那么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，最终为学习者，患者安全和临床结果带来好处。此外，该课程将作为AHRQ患者安全网络（PSNet）内的资源提供，并作为美国医学院协会（AAMC）MedEdPORTAL内的同行评审资源提交，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.