Mental Practice Enhances Surgical Technical Skills A Randomized Controlled Study

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.