Skip to main content
Erschienen in: Surgical Endoscopy 1/2010

01.01.2010

Development and validation of mental practice as a training strategy for laparoscopic surgery

verfasst von: Sonal Arora, Rajesh Aggarwal, Nick Sevdalis, Aidan Moran, Pramudith Sirimanna, Roger Kneebone, Ara Darzi

Erschienen in: Surgical Endoscopy | Ausgabe 1/2010

Einloggen, um Zugang zu erhalten

Abstract

Background

Concerns for patient safety have accelerated the need for alternative training strategies outside the operating room. Mental practice (MP: the use of mental imagery to rehearse a task symbolically before performance) has been used successfully in sports and music to enhance skill. This study aimed to develop and validate a MP training strategy for laparoscopic surgery.

Methods

A cognitive “walk through” was conducted for a laparoscopic cholecystectomy (LC) to identify key visual, cognitive, and kinesthetic cues for the procedure. This was used to develop a MP training protocol featuring an “MP script” to enhance mental imagery of a LC. The script was validated by asking each subject to rehearse mentally a LC within 30 min. Ability to practice this procedure mentally was assessed before and after MP training with a modified version of a validated questionnaire (minimum score, 8; maximum score, 56).

Results

The study was completed by 20 subjects (10 experienced surgeons >100 LCs, 10 novice surgeons <10 LCs). Reliability testing of the questionnaire gave it a Cronbach alpha of 0.984 (n = 20) before MP training and 0.879 (n = 20) after MP training, indicating internal consistency. The construct validity of the questionnaire is supported by the fact that the experienced surgeons scored higher on all the questions than the novices both before and after training. Significant improvement in global imagery score after MP was shown by both experienced (48 before MP vs. 53 after MP; p = 0.007) and novice (15 before MP vs. 42 after MP; p = 0.005) surgeons, suggesting both face and content validity.

Conclusions

This is the first study to develop and validate MP as a novel training approach for laparoscopic surgery. Mental practice may be a time- and cost-effective strategy that improves surgeons’ ability to visualize themselves performing a LC, increasing both their knowledge and confidence.
Literatur
1.
Zurück zum Zitat Department of Health (2006) Good doctors, safer patients—proposal to strengthen the system to assure and improve the performance of doctors and to protect the safety of patients. Department of Health, London, pp 1–202 Department of Health (2006) Good doctors, safer patients—proposal to strengthen the system to assure and improve the performance of doctors and to protect the safety of patients. Department of Health, London, pp 1–202
2.
Zurück zum Zitat Tooke J (2008) Aspiring to excellence: final report of the independent inquiry into modernising medical careers. MMC Inquiry, London Tooke J (2008) Aspiring to excellence: final report of the independent inquiry into modernising medical careers. MMC Inquiry, London
3.
Zurück zum Zitat Aggarwal R, Moorthy K, Darzi A (2004) Laparoscopic skills training and assessment. Br J Surg 91:1549–1558CrossRefPubMed Aggarwal R, Moorthy K, Darzi A (2004) Laparoscopic skills training and assessment. Br J Surg 91:1549–1558CrossRefPubMed
4.
Zurück zum Zitat Grantcharov TP, Kristiansen VB, Bendix J, Bardram L, Rosenberg J, Funch-Jensen P (2004) Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg 91:146–150CrossRefPubMed Grantcharov TP, Kristiansen VB, Bendix J, Bardram L, Rosenberg J, Funch-Jensen P (2004) Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg 91:146–150CrossRefPubMed
5.
Zurück zum Zitat Kohn LT, Corrigan JM, Donaldson MS (eds) (2000) To err is human: building a safer health system. National Academy Press, Washington, DC Kohn LT, Corrigan JM, Donaldson MS (eds) (2000) To err is human: building a safer health system. National Academy Press, Washington, DC
6.
Zurück zum Zitat Grantcharov TP, Bardram L, Funch-Jensen P, Rosenberg J (2003) Learning curves and impact of previous operative experience on performance on a virtual reality simulator to test laparoscopic surgical skills. Am J Surg 185:146–149CrossRefPubMed Grantcharov TP, Bardram L, Funch-Jensen P, Rosenberg J (2003) Learning curves and impact of previous operative experience on performance on a virtual reality simulator to test laparoscopic surgical skills. Am J Surg 185:146–149CrossRefPubMed
7.
Zurück zum Zitat Gallagher AG, Satava RM (2002) Virtual reality as a metric for the assessment of laparoscopic psychomotor skills: learning curves and reliability measures. Surg Endosc 16:1746–1752CrossRefPubMed Gallagher AG, Satava RM (2002) Virtual reality as a metric for the assessment of laparoscopic psychomotor skills: learning curves and reliability measures. Surg Endosc 16:1746–1752CrossRefPubMed
8.
Zurück zum Zitat Sutherland LM, Middleton PF, Anthony A, Hamdorf J, Cregan P, Scott D, Maddern GJ (2006) Surgical simulation: a systematic review. Ann Surg 243:291–300CrossRefPubMed Sutherland LM, Middleton PF, Anthony A, Hamdorf J, Cregan P, Scott D, Maddern GJ (2006) Surgical simulation: a systematic review. Ann Surg 243:291–300CrossRefPubMed
9.
Zurück zum Zitat Issenberg SB, McGaghie WC, Hart IR, Mayer JW, Felner JM, Petrusa ER, Waugh RA, Brown DD, Safford RR, Gessner IH, Gordon DL, Ewy GA (1999) Simulation technology for health care professional skills training and assessment. JAMA 282:861–866CrossRefPubMed Issenberg SB, McGaghie WC, Hart IR, Mayer JW, Felner JM, Petrusa ER, Waugh RA, Brown DD, Safford RR, Gessner IH, Gordon DL, Ewy GA (1999) Simulation technology for health care professional skills training and assessment. JAMA 282:861–866CrossRefPubMed
10.
Zurück zum Zitat Kneebone RL, Kidd J, Nestel D, Barnet A, Lo B, King R, Yang GZ, Brown R (2005) Blurring the boundaries: scenario-based simulation in a clinical setting. Med Educ 39:580–587CrossRefPubMed Kneebone RL, Kidd J, Nestel D, Barnet A, Lo B, King R, Yang GZ, Brown R (2005) Blurring the boundaries: scenario-based simulation in a clinical setting. Med Educ 39:580–587CrossRefPubMed
11.
Zurück zum Zitat Sturm LP, Windsor JA, Cosman PH, Cregan P, Hewett PJ, Maddern GJ (2008) A systematic review of skills transfer after surgical simulation training. Ann Surg 248:166–179CrossRefPubMed Sturm LP, Windsor JA, Cosman PH, Cregan P, Hewett PJ, Maddern GJ (2008) A systematic review of skills transfer after surgical simulation training. Ann Surg 248:166–179CrossRefPubMed
12.
Zurück zum Zitat Seymour NE, Gallagher AG, Roman SA, O’Brien MK, Bansal VK, Andersen DK, Satava RM, Seymour NE, Gallagher AG, Roman SA, O’Brien MK, Bansal VK, Andersen DK, Satava RM (2002) Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 236:458–463CrossRefPubMed Seymour NE, Gallagher AG, Roman SA, O’Brien MK, Bansal VK, Andersen DK, Satava RM, Seymour NE, Gallagher AG, Roman SA, O’Brien MK, Bansal VK, Andersen DK, Satava RM (2002) Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 236:458–463CrossRefPubMed
13.
Zurück zum Zitat Haluck RS, Marshall RL, Krummel TM, Melkonian MG, Haluck RS, Marshall RL, Krummel TM, Melkonian MG (2001) Are surgery training programs ready for virtual reality? A survey of program directors in general surgery. J Am Coll Surg 193:660–665CrossRefPubMed Haluck RS, Marshall RL, Krummel TM, Melkonian MG, Haluck RS, Marshall RL, Krummel TM, Melkonian MG (2001) Are surgery training programs ready for virtual reality? A survey of program directors in general surgery. J Am Coll Surg 193:660–665CrossRefPubMed
14.
Zurück zum Zitat Sachdeva AK, Pellegrini CA, Johnson KA (2008) Support for simulation-based surgical education through American College of Surgeons—accredited education institutes. World J Surg 32:196–207CrossRefPubMed Sachdeva AK, Pellegrini CA, Johnson KA (2008) Support for simulation-based surgical education through American College of Surgeons—accredited education institutes. World J Surg 32:196–207CrossRefPubMed
15.
Zurück zum Zitat Driskell JE, Copper C, Moran A (1994) Does mental practice enhance performance? J Appl Psychol 79:481–492CrossRef Driskell JE, Copper C, Moran A (1994) Does mental practice enhance performance? J Appl Psychol 79:481–492CrossRef
16.
Zurück zum Zitat Martin KA, Moritz SE, Hall CR (1999) Imagery use in sport: a literature review and applied model. Sport Psychol 13:245–268 Martin KA, Moritz SE, Hall CR (1999) Imagery use in sport: a literature review and applied model. Sport Psychol 13:245–268
17.
Zurück zum Zitat Wohldmann EL, Healy AR, Bourne LE Jr (2008) A mental practice superiority effect. J Exp Psych Learning, Memory Cognition 34:823–833CrossRef Wohldmann EL, Healy AR, Bourne LE Jr (2008) A mental practice superiority effect. J Exp Psych Learning, Memory Cognition 34:823–833CrossRef
18.
Zurück zum Zitat De Lange FP, Roelofs K, Toni I (2008) Motor imagery: a window into the mechanisms and alterations of the motor system. Cortex 44:494–506CrossRefPubMed De Lange FP, Roelofs K, Toni I (2008) Motor imagery: a window into the mechanisms and alterations of the motor system. Cortex 44:494–506CrossRefPubMed
19.
Zurück zum Zitat Munzert J, Lorey B, Zentgraf K (2009) Cognitive motor processes: the role of motor imagery in the study of motor representations. Brain Res Rev 60(2):306–326CrossRefPubMed Munzert J, Lorey B, Zentgraf K (2009) Cognitive motor processes: the role of motor imagery in the study of motor representations. Brain Res Rev 60(2):306–326CrossRefPubMed
20.
Zurück zum Zitat Bertollo M, Saltarelli B, Robazza C (2009) Mental preparation strategies of elite modern pentathletes. Psychol Sport Exerc 10:244–254CrossRef Bertollo M, Saltarelli B, Robazza C (2009) Mental preparation strategies of elite modern pentathletes. Psychol Sport Exerc 10:244–254CrossRef
21.
Zurück zum Zitat Weinberg R (2008) Does imagery work? Effects on performance and mental skills. J Imag Res Sport Physical Act 3:1–21 Weinberg R (2008) Does imagery work? Effects on performance and mental skills. J Imag Res Sport Physical Act 3:1–21
22.
Zurück zum Zitat Rogers RG (2006) Mental practice and acquisition of motor skills: examples from sports training and surgical education. Obstet Gynecol Clin North Am 33:297–304CrossRefPubMed Rogers RG (2006) Mental practice and acquisition of motor skills: examples from sports training and surgical education. Obstet Gynecol Clin North Am 33:297–304CrossRefPubMed
23.
Zurück zum Zitat Sanders CW, Sadoski M, Bramson R, Wiprud R, Van Walsum K (2004) Comparing the effects of physical practice and mental imagery rehearsal on learning basic surgical skills by medical students. Am J Obstet Gynecol 191:1811–1814CrossRefPubMed Sanders CW, Sadoski M, Bramson R, Wiprud R, Van Walsum K (2004) Comparing the effects of physical practice and mental imagery rehearsal on learning basic surgical skills by medical students. Am J Obstet Gynecol 191:1811–1814CrossRefPubMed
24.
Zurück zum Zitat Sanders CW, Sadoski M, van Walsum K, Bramson R, Wiprud R, Fossum TW (2008) Learning basic surgical skills with mental imagery: using the simulation centre in the mind. Med Educ 42:607–612CrossRefPubMed Sanders CW, Sadoski M, van Walsum K, Bramson R, Wiprud R, Fossum TW (2008) Learning basic surgical skills with mental imagery: using the simulation centre in the mind. Med Educ 42:607–612CrossRefPubMed
25.
Zurück zum Zitat Murphy SM (1994) Imagery interventions in sport. Med Sci Sports Exerc 26:486–494PubMed Murphy SM (1994) Imagery interventions in sport. Med Sci Sports Exerc 26:486–494PubMed
26.
Zurück zum Zitat Immenroth M, Burger T, Brenner J, Nagelschmidt M, Eberspacher H, Troidl H (2007) Mental training in surgical education: a randomized controlled trial. Ann Surg 245:385–391CrossRefPubMed Immenroth M, Burger T, Brenner J, Nagelschmidt M, Eberspacher H, Troidl H (2007) Mental training in surgical education: a randomized controlled trial. Ann Surg 245:385–391CrossRefPubMed
27.
Zurück zum Zitat Cumming J, Olphin T, Law M (2007) Self-reported psychological states and physiological responses to different types of motivational general imagery. J Sports Exerc Psychol 29:629–644 Cumming J, Olphin T, Law M (2007) Self-reported psychological states and physiological responses to different types of motivational general imagery. J Sports Exerc Psychol 29:629–644
28.
Zurück zum Zitat Ericsson KA (2006) Protocol analysis and expert thought: concurrent verbalization of thinking during experts’ performance on representative thoughts. In: Ericsson KA, Charness N, Feltovich PJ, Hoffman RR (eds) The Cambridge handbook of expertise and expert performance. Cambridge University Press, Cambridge, MA Ericsson KA (2006) Protocol analysis and expert thought: concurrent verbalization of thinking during experts’ performance on representative thoughts. In: Ericsson KA, Charness N, Feltovich PJ, Hoffman RR (eds) The Cambridge handbook of expertise and expert performance. Cambridge University Press, Cambridge, MA
29.
Zurück zum Zitat Mays N, Pope C (1995) Rigour and qualitative research. BMJ 311:109–112PubMed Mays N, Pope C (1995) Rigour and qualitative research. BMJ 311:109–112PubMed
30.
Zurück zum Zitat Joice P, Hanna GB, Cuschieri A (1998) Errors enacted during endoscopic surgery: a human reliability analysis. Appl Ergon 29:409–414CrossRefPubMed Joice P, Hanna GB, Cuschieri A (1998) Errors enacted during endoscopic surgery: a human reliability analysis. Appl Ergon 29:409–414CrossRefPubMed
31.
Zurück zum Zitat Cumming J, Ramsey R (2009) Imagery interventions in sport. In: Mellalieu SD, Hanton S (eds) Advances in applied sport psychology: a review. Routledge, London, pp 5–36 Cumming J, Ramsey R (2009) Imagery interventions in sport. In: Mellalieu SD, Hanton S (eds) Advances in applied sport psychology: a review. Routledge, London, pp 5–36
32.
Zurück zum Zitat Anshel MH, Weinberg RS (1996) Coping with acute stress among American and Australian basketball referees. J Sport Behav 19:180–203 Anshel MH, Weinberg RS (1996) Coping with acute stress among American and Australian basketball referees. J Sport Behav 19:180–203
33.
Zurück zum Zitat Fourkas AD, Bonavolonta V, Avenanti A, Aglioti SM (2008) Kinesthetic imagery and tool-specific modulation of corticospinal representations in expert tennis players. Cereb Cortex 18:2382–2390CrossRefPubMed Fourkas AD, Bonavolonta V, Avenanti A, Aglioti SM (2008) Kinesthetic imagery and tool-specific modulation of corticospinal representations in expert tennis players. Cereb Cortex 18:2382–2390CrossRefPubMed
34.
Zurück zum Zitat Feltz D, Landers D (1983) The effect of mental practice on motor skill learning and performance: a metaanalysis. J Sports Psychol 2:210–220 Feltz D, Landers D (1983) The effect of mental practice on motor skill learning and performance: a metaanalysis. J Sports Psychol 2:210–220
35.
Zurück zum Zitat Hinshaw K (1991) The effects of mental practice on motor skill performance: critical evaluation and metaanalysis. Imagination Cognition Personality 3:11–35 Hinshaw K (1991) The effects of mental practice on motor skill performance: critical evaluation and metaanalysis. Imagination Cognition Personality 3:11–35
36.
Zurück zum Zitat Arora S, Sevdalis N, Woloshynowych M, Nestel D, Kneebone R (2009) Managing intra-operative stress: what do surgeons want from a crisis training programme? Am J Surg 197(4):537–543CrossRefPubMed Arora S, Sevdalis N, Woloshynowych M, Nestel D, Kneebone R (2009) Managing intra-operative stress: what do surgeons want from a crisis training programme? Am J Surg 197(4):537–543CrossRefPubMed
Metadaten
Titel
Development and validation of mental practice as a training strategy for laparoscopic surgery
verfasst von
Sonal Arora
Rajesh Aggarwal
Nick Sevdalis
Aidan Moran
Pramudith Sirimanna
Roger Kneebone
Ara Darzi
Publikationsdatum
01.01.2010
Verlag
Springer-Verlag
Erschienen in
Surgical Endoscopy / Ausgabe 1/2010
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-009-0624-y

Weitere Artikel der Ausgabe 1/2010

Surgical Endoscopy 1/2010 Zur Ausgabe

News and notices

News and Notices

Chirurginnen und Chirurgen sind stark suizidgefährdet

07.05.2024 Suizid Nachrichten

Der belastende Arbeitsalltag wirkt sich negativ auf die psychische Gesundheit der Angehörigen ärztlicher Berufsgruppen aus. Chirurginnen und Chirurgen bilden da keine Ausnahme, im Gegenteil.

Echinokokkose medikamentös behandeln oder operieren?

06.05.2024 DCK 2024 Kongressbericht

Die Therapie von Echinokokkosen sollte immer in spezialisierten Zentren erfolgen. Eine symptomlose Echinokokkose kann – egal ob von Hunde- oder Fuchsbandwurm ausgelöst – konservativ erfolgen. Wenn eine Op. nötig ist, kann es sinnvoll sein, vorher Zysten zu leeren und zu desinfizieren. 

Recycling im OP – möglich, aber teuer

05.05.2024 DCK 2024 Kongressbericht

Auch wenn sich Krankenhäuser nachhaltig und grün geben – sie tragen aktuell erheblich zu den CO2-Emissionen bei und produzieren jede Menge Müll. Ein Pilotprojekt aus Bonn zeigt, dass viele Op.-Abfälle wiederverwertet werden können.

Im OP der Zukunft läuft nichts mehr ohne Kollege Roboter

04.05.2024 DCK 2024 Kongressbericht

Der OP in der Zukunft wird mit weniger Personal auskommen – nicht, weil die Technik das medizinische Fachpersonal verdrängt, sondern weil der Personalmangel es nötig macht.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.