title: Application of Mental Skills Training in Surgery: A Review of Its Effectiveness and Proposed Next Steps.
abstract: BACKGROUND
  Mental skills training, which refers to the teaching of performance enhancement and stress management psychological strategies, may benefit surgeons. Our objective was to review the application of mental skills training in surgery and contrast it to other domains, examine the effectiveness of this approach in enhancing surgical performance and reducing stress, and provide future directions for mental skills training in surgery.
  
  
  METHODS
  A systematic literature search of MEDLINE, PubMed, PsycINFO, and ClinicalKey was performed between 1996 and 2016. Keywords included were mental readiness, mental competency, mental skill, mental practice, imagery, mental imagery, mental rehearsal, stress management training, stress coping, mental training, performance enhancement, and surgery. Reviews of mental skills interventions in sport and well-regarded sport psychology textbooks were also reviewed. Primary outcome of interest was the effect of mental skills on surgical performance in the simulated or clinical environment.
  
  
  RESULTS
  Of 490 identified abstracts, 28 articles met inclusion criteria and were reviewed. The majority of the literature provides evidence that mental imagery and stress management training programs are effective at enhancing surgical performance and reducing stress. Studies from other disciplines suggest that comprehensive mental skills programs may be more effective than imagery and stress management techniques alone.
  
  
  CONCLUSIONS
  Given the demonstrated efficacy of mental imagery and stress management training in surgery and the incremental value of comprehensive mental skills curricula used in other domains, a concerted effort should be made to apply comprehensive mental skills curricula during surgical training.
authors.affiliation: 1 Department of Surgery, Indiana University School of Medicine , Indianapolis, Indiana.
authors.forename: Nicholas E
authors.initials: NE
authors.lastname: Anton
authors.affiliation: 2 Get a Strong Mind, Inc. , San Diego, California.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Bean
authors.affiliation: 3 Department of Orthopedics, Akron General Medical Center , Akron, Ohio.
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Hammonds
authors.affiliation: 1 Department of Surgery, Indiana University School of Medicine , Indianapolis, Indiana.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Stefanidis
mesh_terms: D000223:Adaptation, Psychological; D002983:Clinical Competence; D006801:Humans; D011214:Practice, Psychological; D000067450:Psychology, Sports; D011597:Psychomotor Performance; D013315:Stress, Psychological / Q000517:prevention & control*; D066231:Surgeons / Q000193:education* / Q000523:psychology*
keywords: mental skills; mental skills training; mental training; performance enhancement; review; stress; stress management training; surgeons; surgery