Abstract
Objective. Motor imagery (MI) is widely used to improve technical skills in sports and has been proven to be effective in neurorehabilitation and surgical education. This review aims to identify the key characteristics of MI protocols for implementation into surgical curricula. Design. This study is a systematic review and meta-analysis. PubMed, MEDLINE, Embase and PsycINFO databases were systematically searched. The primary outcome was the impact of MI training on measured outcomes, and secondary outcomes were study population, MI intervention characteristics, study primary outcome measure and subject rating of MI ability (systematic review registration: PROSPERO CRD42019121895). Results. 456 records were screened, 60 full texts randomising 2251 participants were reviewed and 39 studies were included in meta-analysis. MI was associated with improved outcome in 35/60 studies, and pooled analysis also showed improved outcome on all studies with a standardised mean difference of .39 (95% CI: .12, .67, P = .005). In studies where MI groups showed improved outcomes, the median duration of training was 24 days (mode 42 days), and the median duration of each individual MI session was 30 minutes (range <1 minute-120 minutes). Conclusions. MI training protocols for use in surgical education could have the following characteristics: MI training delivered in parallel to existing surgical training, in a flexible format; inclusion of a brief period of relaxation, followed by several sets of repetitions of MI and a refocusing period. This is a step towards the development of a surgical MI training programme, as a low-cost, low-risk tool to enhance practical skills.
Highlights
Surgical education has been increasingly reliant on training methods which involve simulation, ranging from simple bench models to virtual reality simulation and box trainers.[1]
Exclusion criteria were as follows: studies which were not randomised controlled trials (RCTs); studies in which Motor imagery (MI) training was combined with simulation training; studies in which MI training was done in conjunction with functional magnetic resonance imaging, electroencephalograms (EEG), electromyography (EMG), transcutaneous electric nerve stimulation (TENS), electroacupuncture or hypnosis
The results of this review may aid in constructing a purpose-built MI training programme to evaluate its efficacy on surgical trainees. This comprehensive systematic review and meta-analysis has identified several characteristics linked to successful MI training in sports or neurorehabilitation that can be used to construct MI training protocols for use in surgical education
Summary
Surgical education has been increasingly reliant on training methods which involve simulation, ranging from simple bench models to virtual reality simulation and box trainers.[1] Motor imagery (MI) can be described as a form of simulation; it consists of imagining oneself performing a voluntary movement, without physically moving.[2] It has been called mental practice (MP), mental training and mental imagery. Motor imagery has been proven to be effective at improving technical skills in various fields,[3,4,5,6] and structured training programmes which incorporate this concept are reported in the literature. MI has been integrated in several models such as the PETTLEP model[7] which delivers a format of training applicable to different sports. In the field of neurorehabilitation, Braun’s review[8] identified the elements which correlate with effective training outcomes
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