title: Development and validation of mental practice as a training strategy for laparoscopic surgery.
abstract: BACKGROUND
  Concerns for patient safety have accelerated the need for alternative training strategies outside the operating room. Mental practice (MP: the use of mental imagery to rehearse a task symbolically before performance) has been used successfully in sports and music to enhance skill. This study aimed to develop and validate a MP training strategy for laparoscopic surgery.
  
  
  METHODS
  A cognitive "walk through" was conducted for a laparoscopic cholecystectomy (LC) to identify key visual, cognitive, and kinesthetic cues for the procedure. This was used to develop a MP training protocol featuring an "MP script" to enhance mental imagery of a LC. The script was validated by asking each subject to rehearse mentally a LC within 30 min. Ability to practice this procedure mentally was assessed before and after MP training with a modified version of a validated questionnaire (minimum score, 8; maximum score, 56).
  
  
  RESULTS
  The study was completed by 20 subjects (10 experienced surgeons >100 LCs, 10 novice surgeons <10 LCs). Reliability testing of the questionnaire gave it a Cronbach alpha of 0.984 (n = 20) before MP training and 0.879 (n = 20) after MP training, indicating internal consistency. The construct validity of the questionnaire is supported by the fact that the experienced surgeons scored higher on all the questions than the novices both before and after training. Significant improvement in global imagery score after MP was shown by both experienced (48 before MP vs. 53 after MP; p = 0.007) and novice (15 before MP vs. 42 after MP; p = 0.005) surgeons, suggesting both face and content validity.
  
  
  CONCLUSIONS
  This is the first study to develop and validate MP as a novel training approach for laparoscopic surgery. Mental practice may be a time- and cost-effective strategy that improves surgeons' ability to visualize themselves performing a LC, increasing both their knowledge and confidence.
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College, St. Mary's Hospital, 10th Floor QEQM Building, London, UK. Sonal.Arora06@imperial.ac.uk
authors.forename: Sonal
authors.initials: S
authors.lastname: Arora
authors.forename: Rajesh
authors.initials: R
authors.lastname: Aggarwal
authors.forename: Nick
authors.initials: N
authors.lastname: Sevdalis
authors.forename: Aidan
authors.initials: A
authors.lastname: Moran
authors.forename: Pramudith
authors.initials: P
authors.lastname: Sirimanna
authors.forename: Roger
authors.initials: R
authors.lastname: Kneebone
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000193:education*; D002983:Clinical Competence; D003071:Cognition; D003162:Competency-Based Education; D004503:Education, Medical, Graduate; D004521:Educational Measurement; D005260:Female; D006801:Humans; D019018:Imagery, Psychotherapy; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D011597:Psychomotor Performance; D055815:Young Adult