Development and Validation of Mental Practice as a Training Strategy for Abdominal Hysterectomy

Abstract

Local Mentor: Lorraine Dugoff, MD APGO Advisor: Alice R. Goepfert, MD PURPOSE: To develop and validate a Mental Practice tool for resident training in abdominal hysterectomy. BACKGROUND: Abdominal hysterectomy is a common operation performed by obstetrician-gynecologists. Training opportunities for this procedure are diminishing due to many factors. Mental Practice (the use of mental imagery to rehearse a task symbolically before performance) has been used successfully in sports and music to enhance skill. This strategy demonstrates benefit in existing surgical education literature. METHODS: A Mental Practice script was developed by taking expert surgeons through a cognitive walk-through to identify key procedural cues. For validation, resident and attending gynecologic surgeons mentally rehearsed abdominal hysterectomy. Ability to mentally practice this procedure was assessed before and after exposure to the tool. We used a validated 7-point Likert scale questionnaire composed of 8 questions (MIQ: Mental Imagery Questionnaire, 56 points). EVALUATION: The study included 16 subjects, with experience ranging from 0 to >100 procedures. Reliability testing of the questionnaire (Cronbach alpha 0.915 before Mental Practice training and 0.933 after) indicated internal consistency. Construct validity was also supported. Significant improvement in MIQ score after use of the tool was shown by residents (39 versus 44; P=.003). Attending scores also improved but not significantly (54 versus 55; P=.066), suggesting a ceiling effect. A linear relationship was evident between the benefit of the tool and experience (P=.051). DISSEMINATION: A larger study is planned to determine the effect of mental practice on surgical performance for residents. REFLECTIVE CRITIQUE: The tool was most useful for trainees with the least surgical experience.