Thinking it Through: Correlation of Mental Rehearsal Attitudinal Gains with Performance Parameters on Two Separate Laparoscopic Cholecystectomy Trainers.

Slides:

Advertisements

Similar presentations

Template: Making Effective Presentation about Your Evidence-based Health Promotion Program This template is intended for you to adapt to your own program.

Advertisements

Randomized prospective evaluation of surgical trainees in 'warm up' simulations of laparoscopic ventral hernia repair Richardson, C MD, St. Hill, C MD,

Understanding and Using Imagery in Sport

Evaluating the Reliability and Validity of the Family Conference OSCE Across Multiple Training Sites Jeffrey G. Chipman MD, Constance C. Schmitz PhD, Travis.

Impact of a Structured Skills Lab Curriculum on Operative Judgment Deb DaRosa, David Rogers, Reed Williams, Linnea Hauge, Ken Murayama, Alex Nagle, Keith.

Self-Assessment of Surgical Skill Acquisition with Computer-Based Video Training and the Impact on Self-Directed Training Nathan Jowett Vicki LeBlanc George.

Course: Helping Babies Breathe (HBB) is a new evidence-based neonatal resuscitation education curriculum specifically designed for low resource countries.

JS Tsang, QMH Joint Hospital Grand Round 26 th April 2014.

GME Lunch n Learn Series Cuc Mai September Common Program Requirements: Competency-based goals and objectives for each assignment at each educational.

Stanford Vascular Surgery Simulation-based Endovascular Skills Assessment: The Future of Credentialing? Maureen M. Tedesco, Jimmy J. Pak, E. John Harris,

The Xitact Platform for Laparoscopic Surgery Training Ivan Večerina, M.D. – Xitact S.A. MMVR11, 2003 LS 500 Trainer Platform.

Visual Spatial Ability – Are Surgeons Born or Made? Zackary Boom-Saad, Pamela Andreatta, EdD, Miranda L. Hillard, Anthony G. Gallagher, PhD †, Scott Langenecker,

Daniel Farkas, Kamal Nagpal, Ernesto Curras, Ajay Shah, John Cosgrove

Skill Learning: Types of Practice

Chapter 19 Mental Practice

Debriefing in Medical Simulation Manu Madhok, MD, MPH Emergency Department Children’s Hospital and Clinics of Minnesota.

Teaching Quality Improvement: A Needs Assessment for OBGYN Resident Education Teaching Quality Improvement: A Needs Assessment for OBGYN Resident Education.

Core Competency Assessment in Emergency Medicine from Design to Implementation National Hispanic Medical Conference Christian Arbelaez, MD, MPH Associate.

Laparoscopic Skills Laboratories: Current Assessment and a Call for Resident Training Standards James R. Korndorffer, Jr., MD, Dimitris Stefanidis, MD,

John T. Paige MD, Deborah D. Garbee PhD, APRN, ACNS- BC, Vadym Rusnak MD, Qingzhao Yu PhD, Richard DiCarlo MD, Alan Marr MD LSU Health New Orleans (NO)

Comparing Video Games and Laparoscopic Simulators in the Development of Laparoscopic Skills in Surgical Residents Barbara J. Adams MD, Franklin Margaron.

Fund of Knowledge: Basic research methodology Pre-test mean: 56% ± 8% Post-test mean: 65% ± 6% N=11, p value

Ganesh Sankaranarayanan PhD April 24, 2013 Orlando/ASE 2013 The Learning Plateau and the Learning Rate for the VBLaST PT© compared to the FLS simulator.

Competency of Psychiatry Residents in the Treatment of Severe Mental Illness Before and After a Psychiatric Rehabilitation Community Rotation Melinda Randall.

Objective Evaluation of Sonographic Skill in Focussed Assessment with Sonography for Trauma (FAST) Examinations Matthew S. Holden 1, Tamas Ungi 1, Conor.

EVALUATION OF THE COUNSELING PRACTICUM AS AN EFFECTIVE METHOD TO TEACH COUNSELING SKILLS TO DOCTORS Mary Dankoski, Ph.D. Shobha Pais, Ph.D. Kathy Zoppi,

Background: As students complete their clerkships throughout their M3 year they gain in clinical experience and confidence, which may translate into improved.

Can a Brief On-line Education Tool Improve Surgical Resident Operative Dictations? A Prospective Evaluation Alicia Kieninger, MD, Yi Wei Zhang, MD, Anna.

Medical Students’ Self-Ratings of Interprofessionalism Knowledge & Performance Before & After Simulation-Based Education David B. Trinkle, MD; David W.

Proficiency of surgical faculty and residents with ethical dilemmas: Is modeling enough? Kamela K. Scott, PhD David J. Chesire, PhD J. Bracken Burns, Jr,

KidSIM Journal Club Presenter: Amani Azizalrahman June 19 th, 2014.

In order to improve the Family Medicine obstetrics (OB) rotation orientation and to encourage resident- resident teaching, we developed an orientation.

Feasibility and Value of a Procedural Workshop for Surgery Residents Based on Phase-II of the APDS/ ACS National Skills Curriculum Dimitrios Stefanidis.

Implementation of Full Patient Simulation Training in Surgical Residency Gladys L. Fernandez, MD Baystate Medical Center Tufts University School of Medicine.

BOOT CAMP: Educational Outcomes After Four Successive Years of Preparatory Simulation-based Training at Onset of Internship Gladys L Fernandez MD, Richard.

Matthew Schill, BS, Debbie Tiemann, RN, Mary Klingensmith, MD, L. Michael Brunt, MD Department of Surgery and Institute for Minimally Invasive Surgery.

Proficiency-Based Training for Phacoemulsification Princeton Lee Research Fellow RCSI & ICO Alcon Education Night 27/02/2009.

Great Debate: Simulation A Resident’s Perspective Ernest (Ted) Gomez, MD, MTR PGY-3 Resident Department of Otorhinolaryngology – Head and Neck Surgery.

VENTRICULOSTOMY PRACTICE ON A LIBRARY OF VIRTUAL BRAINS USING A VR/HAPTIC SIMULATOR IMPROVES SIMULATOR AND SURGICAL OUTCOMES VENTRICULOSTOMY PRACTICE ON.

Training The Spanish Language and Culture Instructors at FSI

Neal E. Seymour, MD Baystate Medical Center Tufts University School of Medicine Baystate Simulation Center—Goldberg Surgical Skills Lab 2010 APDS Annual.

J. Aaron Johnson, PhD 1 and J. Paul Seale, MD 2 1 Institute of Public and Preventive Health and Department of Psychology, Georgia Regents University, Augusta,

Comparing Performance on the Virtual Laparoscopic and Robotic Simulators Among Medical Students Pursuing Surgical versus Non-surgical Residencies Amanda.

Department of Surgery Development of PGY-1 Surgery Preparatory Course Curricula: Identification of Key Curricular Components Mara B. Antonoff MD Jonathan.

An Online Self-Directed Research Curriculum Adrienne A. Williams, PhD Shana O. Ntiri, MD, MPH.

Use of Simulation-Based Surgical Education and Training Within the Context of the Core Competencies, Milestones, Patient Safety, and the New ACGME Accreditation.

1 Utilization of Operating Room Simulation and Debriefing to Enhance Surgical Resident Participation in the Surgical Timeout Checklist Edward Dominguez.

NEW DIRECTIONS IN SURGICAL EDUCATION AND TRAINING Ajit K. Sachdeva, MD, FRCSC, FACS Director, Division of Education American College of Surgeons Challenges.

A New Model for Assessing Teaching Quality Improvement to Family Medicine Residents Does It Work? Fred Tudiver, Ivy Click, Jeri Ann Basden Department of.

Introduction of a Comprehensive Training Curriculum in Laparoscopic Surgery for Medical Students: A Randomized Trial. N Gawad, EM Bonrath, NJ Dedy, B Zevin,

The Effect of Positive and Negative Verbal Feedback on Surgical Skills Performance and Motivation Aarthy Kannappan, MD Dana Yip, MD Nayna Lodhia, BS John.

References Results Conclusions Figures/Graphs The Impact of Interdisciplinary Education on Skills and Attitudes of Emergency Medicine & General Surgery.

Design and Evaluation of a Virtual Reality Simulation Module for Training Advanced Temporal Bone Surgery Sudanthi Wijewickrema Department of Surgery (Otolaryngology)

Department of Obstetrics, Gynecology & Reproductive Sciences , YSM

Oh, Kenny J. , Esposito, Andrew

Prebriefing: The Final Frontier

Quantitative Evaluation of Surgical Skills Learned in Simulation

By Marina Yiasemidou Under the Supervision of

Simulated Procedures in Family Medicine

Maureen Gecht-Silver OTR/L, MPH UIC Department of Family Medicine

MUSC College of Medicine New Faculty Orientation

Dana Keener, Ph.D. ICF Macro 2009 AEA Annual Meeting November 12, 2009

The Most Gracious and The Most Merciful.

Background and Objectives

Motor Learning Exam 3 Review

Sonal Arora PhD MBBS MRCS BSc(hons)

Chapter Six Training Evaluation.

Louanne Friend, PhD; Catherine Skinner, MD The University of Alabama

Laura Beyer-Berjot, MD, Vanessa Palter, MD, PhD,

The impact of small-group EBP education programme: barriers and facilitators for EBP allied health champions to share learning with peers.

Presentation transcript:

Thinking it Through: Correlation of Mental Rehearsal Attitudinal Gains with Performance Parameters on Two Separate Laparoscopic Cholecystectomy Trainers John T. Paige, M.D., Qingzhao Yu, Ph.D., Alan Marr, M.D., Lance Stuke, M.D., M.P.H., John Hunt, M.D., M.P.H. 6 th Annual Meeting of the Consortium of ACS-Accredited Education Institutes Chicago, IL March 16, 2013

Funding Support / Disclosures Funding support: LSU Academy for the Advancement of Educational Scholarship Educational Enhancement Grant ( )Funding support: LSU Academy for the Advancement of Educational Scholarship Educational Enhancement Grant ( ) Disclosures: Co-editor for Simulation in RadiologyDisclosures: Co-editor for Simulation in Radiology

Goal Promote the adoption of mental rehearsal in simulation-based training (SBT) to expedite learningPromote the adoption of mental rehearsal in simulation-based training (SBT) to expedite learning

Objectives Describe our laparoscopic cholecystectomy (lap CCY) SBT programDescribe our laparoscopic cholecystectomy (lap CCY) SBT program Evaluate the role of mental rehearsal in lap CCY SBTEvaluate the role of mental rehearsal in lap CCY SBT Discuss future directions of our program and researchDiscuss future directions of our program and research

IDES RIDDLE

BEWARE!

Lap CCY SBT Curriculum

Why Lap CCY? Bread and butter surgery Morbidity risk Introductory case Amenable to SBT Wu YV and Linehan DC, Surg Clin North Am 2010;90: ;90: Procedural Trainer (PT) Virtual Reality (VR) Trainer

Motor Skill Acquisition 1 Fast Phase Immediate improvement from first training session 2 Consolidation Phase Improvement at least 6 hrs from first session 3 Slow Phase Further gains across several training sessions 4 Automatic Phase Motor task performed automatically 5 Retention Phase Motor task executed in absence of any practice after long delay Gatti R et al. Neurosci Lett

Motor Learning Action Observation Observational learning Effective way to learn or enhance the performance of a particular motor skill Recruitment of brain areas involved in motor skills during observation Motor Imagery Mental rehearsal Leads to improvement in motor performance of targeted task(s) Recruitment similar brain areas as in action observation Gatti R et al. Neurosci Lett

Mental Rehearsal Cognitive rehearsal of a taskCognitive rehearsal of a task “Imagery practice”“Imagery practice” “Covert rehearsal”“Covert rehearsal” “Conceptualization”“Conceptualization” “Mental imagery rehearsal”“Mental imagery rehearsal” Rogers RG. Obstet Gynecol Clin N Am 2006; 33:

Effective Characteristics of MR IndividualIndividual SupervisedSupervised Non-directedNon-directed Eyes closedEyes closed Internal perspectiveInternal perspective Kinesthetic modeKinesthetic mode Schuster C. BMC Medicine 2011;9:75.

Prior Studies Lap CCY TrainingBasic Open Skills Sanders CW et al, Med Educ 2008;42: Arora S et al, Ann Surg 2011;253:

Study Question Is there a correlation between mental rehearsal and performance in lap CCY SBT based on the type of simulator used?Is there a correlation between mental rehearsal and performance in lap CCY SBT based on the type of simulator used?

Study Design Lap CCY surgical skills labLap CCY surgical skills lab Prospective analysisProspective analysis Two models of SBTTwo models of SBT Division of trainees based on PGY levelDivision of trainees based on PGY level

Participants General surgical residentsGeneral surgical residents PGY 1 thru 3 levelsPGY 1 thru 3 levels Rotating in New Orleans regionRotating in New Orleans region

Training Format Standardized formatStandardized format Didactic and SBT componentsDidactic and SBT components Distributed trainingDistributed training

Didactic Component Mental rehearsal GroupDetailed Knowledge test MCQDiagram Pre-session reading IndicationsSteps

Mental Rehearsal Step by step verbal recital of lap CCY from start to finish

SBT – PT Trainer

SBT – VR Trainer

Mental Imagery Questionnaire S Arora et al. Surg Endosc. 2010;24:

Simulator Data Time to task completion EfficiencyAccuracy Safe cautery Path length Time to dissect out “critical view”

Statistical Analysis Calculation of scores for each MIQ item, gain scores, time to task completion (Mean values)Calculation of scores for each MIQ item, gain scores, time to task completion (Mean values) Paired t-test analysis of pre/ post-training scores (bonferroni adjustment)Paired t-test analysis of pre/ post-training scores (bonferroni adjustment) Pearson correlations comparing MIQ scores with VR and PT scoresPearson correlations comparing MIQ scores with VR and PT scores p< 0.05 = significantp< 0.05 = significant

Results

Participants Characteristic PT Training in VOR VR Training Full completion SBT (n) 109 PGY 1 (n) 44 PGY 2 (n) 43 PGY 3 (n) 22 Self-report prior lap CCY (n) 16.7 a 10.5 a Self-report lap CCY expertise 2.3 b 2.0 b Peg transfer score (s) Partial completion SBT (n) 1c1c1c1c 1c1c1c1c a n=7, b n=8, c PGY 1

Results MIQ by Item Item Mean Pre-MR Score (SD) a Mean Pre-MR Score (SD) a Mean Post-MR Score (SD) a ∆P-value Energized to do lap CCY 5.5 (1.6) 6.0 (1.3) Confidence re: lap CCY 4.9 (1.7) 5.8 (1.0) 0.9<0.001 Confidence vs colleague 5.0 (1.4) 5.6 (1.1) 0.6<0.001 Helpfulness MR 5.4 (1.2) 5.7 (1.0) “See” self doing lap CCY 5.5 (1.3) 5.9 (1.0) Vividness images 5.6 (1.2) 6.2 (1.0) 0.6<0.001 “Feel” self doing lap CCY 5.3 (1.3) 5.7 (1.0) Talk thru steps 5.8 (1.0) 6.3 (0.9) 0.5<0.001 a n=Paired results for 17 of 19 residents completing training

Simulator Data Task Mean Pre Score, s Mean Post Score, s P value PT – Dissection critical view (n=10) NS VR – Full procedure (n=4) NS VR – Task 1 (n=9) VR – Task 2 (n=9) VR – Task 3 (n=9) VR – Task 4 (n=9) NS

Pearson Correlation Task P value PT – Dissection critical view (n=10) 0.645NS VR – Task 1 (n=9) 0.422NS VR – Task 2 (n=9) VR – Task 3 (n=9) NS VR – Task 4 (n=9) 0.032NS

Training Effectiveness

Discussion

Limitations Small sample sizeSmall sample size Proficiency training was not the goalProficiency training was not the goal Mental rehearsal implementation weaknesses – group based, eyes openMental rehearsal implementation weaknesses – group based, eyes open Outcomes data not collectedOutcomes data not collected

Why Only One Correlation? Most clearly imaginableMost clearly imaginable Most technically oriented of tasksMost technically oriented of tasks Weaknesses in training and mental rehearsal designWeaknesses in training and mental rehearsal design

Conclusions Group mental rehearsal appears to correlate with improved performance related to the two handed clipping and cutting task on VR.Group mental rehearsal appears to correlate with improved performance related to the two handed clipping and cutting task on VR. Group mental rehearsal does not appear to correlate with improved performance on lap CCY training on a procedural trainerGroup mental rehearsal does not appear to correlate with improved performance on lap CCY training on a procedural trainer

Conclusions Such findings may allow targeted use of mental rehearsal to accelerate skill acquisitionSuch findings may allow targeted use of mental rehearsal to accelerate skill acquisition