- 作者：Sonal Arora ; MD ; PhD ; MRCS ; Rajesh Aggarwal ; MD ; PhD ; Louise Hull ; MSc ; Danilo Miskovic ; MD ; Roger Kneebone ; PhD ; Ara Darzi ; MD ; FACS ; Nick Sevdalis ; PhD
- 刊名：Journal of the American College of Surgeons
- 出版年：2011
- 出版时间：September, 2011
- 年：2011
- 卷：213
- 期：3_supp_S
- 页码：S126
- 全文大小：1K
Introduction
Opportunities for experiential learning of technical and non-technical skills required for safe surgery are decreasing. Mental practice (MP), ¡®the cognitive rehearsal of a task prior to performance,' is successfully used in sport to enhance skill. This double-blind randomized-controlled study investigates if MP enhances performance in a laparoscopic crisis within a high-fidelity simulated OR.Methods
Phase 1: An MP training protocol was developed (Cognitive-Task-Analysis) and validated with 20 surgeons and 20 safety experts. Phase 2: A further 32 surgeons (16 attendings,16 residents) were recruited. After baseline testing and familiarization, subjects were randomised to either MP (30 mins of MP) or control group (viewed online lecture). Subsequently, each subject performed a laparoscopic cholecystectomy with multiple crises built into the scenario (eg, bleeding). Performance was assessed using the validated OSATS-based global-ratings scale (technical skill) and OTAS tool (Observational Teamwork Assessment for Surgery) by two trained and calibrated raters.
Results
Inter-rater reliability was high for technical skill (ICC=0.838) and teamwork (ICC=0.746).There were no inter-group differences in baseline ability. For both attendings and residents, the MP group was superior to control in terms of technical skill (MP median 25.0 vs. control median 19.5,p=0.001) and teamwork (MP median 28.0 vs control median 21.5, p=0.001). Technical and team performance also highly correlated (Spearman rho = 0.765, p=0.008).
Conclusions
This is the first study to show that mental practice enhances both technical and team performance in a crisis simulation. MP is a time and cost-effective strategy to augment training in the OR, potentially improving patient care.