title: Mental practice in postgraduate training: a randomized controlled trial in mastoidectomy skills.
abstract: BACKGROUND
  Mental practice, the cognitive rehearsal of a task in the absence of overt physical movement, has been successfully used in teaching complex psychomotor tasks including sports and music, and recently, surgical skills. The objectives of this study were, 1) To develop and evaluate a mental practice protocol for mastoidectomy 2) To assess the immediate impact of mental practice on a mastoidectomy surgical task among senior Otolaryngology─Head & Neck Surgery (OHNS) residents.
  
  
  METHODS
  Three expert surgeons were interviewed using verbal protocol analysis to develop a mastoidectomy mental practice script. Twelve senior Residents from Canadian training programs were randomized into two groups. All Residents were video-recorded performing a baseline mastoidectomy in a temporal bone lab. The intervention group received mental practice training, while the control group undertook self-directed textbook study. All subjects were then video-recorded performing a second mastoidectomy. Changes in pre- and post-test scores using validated expert ratings, the Task Specific Evaluation of Mastoidectomy and the Global Evaluation of Mastoidectomy, were statistically analyzed.
  
  
  RESULTS
  A mental practice script was successfully developed based on interviews of three expert surgeon-educators. Task Specific Evaluation and Global Evaluation scores increased in both the mental practice and textbook study groups; there was no significant difference between the two groups in the change in scores post-intervention. There was a high and statistically signficant correlation between evaluators on the outcome measures.
  
  
  CONCLUSIONS
  We were not able to demonstrate a significant difference for the benefits of mental practice in mastoidectomy, possibly due to the sample size. However, mental practice is a surgical education tool which is portable, accessible, inexpensive and safe.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, B. C. Rotary Hearing and Balance Centre at St Paul's Hospital, University of British Columbia, Providence 2 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Conlin
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, B. C. Rotary Hearing and Balance Centre at St Paul's Hospital, University of British Columbia, Providence 2 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
authors.forename: Jane
authors.initials: J
authors.lastname: Lea
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, NS, Canada.
authors.forename: Manohar
authors.initials: M
authors.lastname: Bance
authors.affiliation: Division of Pediatric Otolaryngology-Head and Neck Surgery, B.C. Children's Hospital, Vancouver, BC, Canada.
authors.forename: Neil
authors.initials: N
authors.lastname: Chadha
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, The Ottawa Hospital, Ottawa, ON, Canada.|Ottawa Hospital Research Institute, Ottawa, ON, Canada.
authors.forename: Shaun
authors.initials: S
authors.lastname: Kilty
authors.affiliation: Division of Pediatric Otolaryngology-Head and Neck Surgery, B.C. Children's Hospital, Vancouver, BC, Canada.
authors.forename: Frederick
authors.initials: F
authors.lastname: Kozak
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, NS, Canada.
authors.forename: Julian
authors.initials: J
authors.lastname: Savage
authors.affiliation: Division of Vascular Surgery, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Ravindar
authors.initials: R
authors.lastname: Sidhu
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.|Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Joseph
authors.initials: J
authors.lastname: Chen
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, B. C. Rotary Hearing and Balance Centre at St Paul's Hospital, University of British Columbia, Providence 2 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. BWesterberg@providencehealth.bc.ca.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Westerberg
mesh_terms: D000328:Adult; D001955:British Columbia; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007407:Interviews as Topic; D008297:Male; D008416:Mastoid / Q000601:surgery*; D008606:Mental Processes; D010036:Otolaryngology / Q000193:education*; D014741:Video Recording
keywords: Education; Graduate; Imagery; Mastoid; Medical; Motor skills