title: Effectiveness of a comprehensive mental skills curriculum in enhancing surgical performance: Results of a randomized controlled trial.
abstract: BACKGROUND
  We hypothesized that the implementation of a novel mental skills curriculum (MSC) during laparoscopic simulator training would improve mental skills and performance, and decrease stress.
  
  
  METHODS
  Sixty volunteer novices were randomized into intervention and control groups. All participants received FLS training while the intervention group also participated in the MSC. Skill transfer and retention were assessed on a live porcine model after training and 2 months later, respectively. Performance was assessed using the Test of Performance Strategies-2 (TOPS-2) for mental skills, FLS metrics for laparoscopic performance, and the State Trait Anxiety Inventory (STAI-6) and heart rate (HR) for stress.
  
  
  RESULTS
  Fifty-five participants (92%) completed training and the transfer test, and 46 (77%) the retention test. There were no significant differences between groups at baseline. Compared to controls the intervention group significantly improved their mental skill use, demonstrated higher laparoscopic skill improvement during retention, and reported less stress during the transfer test.
  
  
  CONCLUSIONS
  The MSC implemented in this study effectively enhanced participants' mental skill use, reduced cognitive stress in the operating room with a small impact on laparoscopic performance.
authors.affiliation: Department of Surgery, Indiana University, Indianapolis, IN, United States; Carolinas Simulation Center, Carolinas HealthCare System, Charlotte, NC, United States. Electronic address: dimstefa@iu.edu.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Stefanidis
authors.affiliation: Department of Surgery, Indiana University, Indianapolis, IN, United States; Carolinas Simulation Center, Carolinas HealthCare System, Charlotte, NC, United States.
authors.forename: Nicholas E
authors.initials: NE
authors.lastname: Anton
authors.affiliation: Association of American Medical Colleges, Washington, DC, United States.
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Howley
authors.affiliation: Get A Strong Mind, Inc, San Diego, CA, United States.
authors.forename: Eric
authors.initials: E
authors.lastname: Bean
authors.affiliation: Carolinas Simulation Center, Carolinas HealthCare System, Charlotte, NC, United States.
authors.forename: Ashley
authors.initials: A
authors.lastname: Yurco
authors.affiliation: Carolinas Simulation Center, Carolinas HealthCare System, Charlotte, NC, United States.
authors.forename: Manuel E
authors.initials: ME
authors.lastname: Pimentel
authors.affiliation: Carolinas Simulation Center, Carolinas HealthCare System, Charlotte, NC, United States.
authors.forename: Cameron K
authors.initials: CK
authors.lastname: Davis
mesh_terms: D001288:Attention; D002983:Clinical Competence; D003479:Curriculum; D005260:Female; D006040:Goals; D006339:Heart Rate; D006801:Humans; D007092:Imagination; D010535:Laparoscopy / Q000193:education*; D008297:Male; D011597:Psychomotor Performance; D012064:Relaxation Therapy; D012153:Retention, Psychology; D000066908:Simulation Training; D016037:Single-Blind Method; D013315:Stress, Psychological; D013850:Thinking; D055815:Young Adult
keywords: Mental skills; Performance enhancement; Simulation; Skill retention; Skills training; Stress management; Surgery