Thinking it Through: Mental Rehearsal and Performance on 2 Types of Laparoscopic Cholecystectomy Simulators

OBJECTIVE: Simulation-based training (SBT) in laparoscopic cholecystectomy (LCCY) provides an opportunity for junior residents to learn the procedure in a safe, non-threatening environment. Mental rehearsal (MR) has the potential of augmenting skill acquisition. This project investigated the correlation between MR of LCCY with performance on 2 different types of simulators: a procedural task (PT) training model and virtual reality (VR) machine. DESIGN: Prospective, quasi-experimental design with purposeful sampling. Postgraduate years (PGYs) 1 through 3 general surgical residents underwent standardized, distributed SBT in LCCY on either a PT trainer or a VR machine with group-based MR undertaken before 2 SBT sessions. Participants completed a pre-MR and post-MR session mental imagery questionnaire (MIQ) containing 8-items using a 7-point Likert-type scale. Data related to VR objective measures and PT video-based performances were also collected. Total scale mean scores were calculated for the first MR session and the second MR session and were compared using the t test. Pearson correlation analysis of MIQ scores with performance scores was determined. SETTING: Louisiana State University Health New Orleans Health Sciences Center in New Orleans, Louisiana. This health sciences center is a tertiary care, academic state institution located in the Southeastern United States. PARTICIPANTS: A total of 21 PGYs 1 through 3 general surgery residents participated. They were purposefully divided into the PT and VR training groups to allow for even PGY distribution. Of the 21 participants, 19 completed both training sessions (n = 10 for PT [PGY1 = 4, PGY2 =4, PGY3 =2] and n = 9 for VR [PGY1 =4, PGY2 = 3, PGY3 = 2]). RESULTS: After the Bonferroni adjustment, significant gains in the MIQ items related to confidence, visual imagery, and knowledge of the procedure were found. VR performance data demonstrated some statistically significant improvements. A significant negative correlation was present between the two-handed clip-and-cut VR task and MIQ gains. CONCLUSIONS: Group MR in LCCY before SBT on a VR machine is related to improved performance time for the VR two-handed clip-and-cut task. MR may be a useful adjunct to SBT LCCY. Future work will look at the translation of these skills to clinical practice. (J Surg 72:740-748. (C) 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)