The mind's scalpel in surgical education: a randomised controlled trial of mental imagery.
OBJECTIVE
To evaluate the role of mental imagery (MI) in resident training for a complex surgical procedure.


METHODS
Randomised controlled trial.


METHODS
Eight centres across Canada and the USA.


METHODS
Junior gynaecology residents who had performed fewer than five vaginal hysterectomies (VH).


METHODS
After performing a pretest VH, junior gynaecology residents were randomised to standard MI versus textbook reading (No MI) and then performed a test VH. Surgeons blinded to group evaluated resident performance on the pretest and test VH via global rating scales (GRS), procedure-specific scales and intraoperative parameters. Residents evaluated their own performance.


METHODS
Change in surgeon GRS score from pretest to test VH. The study was powered to detect a 20% difference in score change.


RESULTS
Fifty residents completed the trial (24 MI, 26 No MI). There was no difference in GRS score change via blinded assessment from pretest to test evaluation between groups (mean change 13% [SD 17] versus 7% [SD 14], P = 0.192). There was no difference in procedure-specific score change. There was a significant difference in self-scored GRS score change between groups (mean change 19% [SD 12] versus 9% [SD 11], P = 0.005). Residents also felt more confident performing a VH (mean change 19% [SD 16] MI versus 11% [SD 10] No MI, P = 0.033).


CONCLUSIONS
No difference was observed in the surgical performance of residents after MI. Improved resident self-confidence may be attributable to MI or the effect of unblinding on trial participants.
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada. roxygeo@hotmail.com
R
R
Geoffrion
J
J
Gebhart
Y
Y
Dooley
A
A
Bent
V
V
Dandolu
R
R
Meeks
K
K
Baker
S
S
Tang
S
S
Ross
M
M
Robert
D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002170:Canada; D002983:Clinical Competence / Q000592:standards; D005260:Female; D006176:Gynecology / Q000193:education*; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000193:education*; D007092:Imagination; D007396:Internship and Residency; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D014481:United States