Guidance hypothesis with verbal feedback in learning a palpation skill. How much feedback is necessary for learning to suture? Emergency skill training--a randomized controlled study on the effectiveness of the 4-stage approach compared to traditional clinical teaching. Application of Motor Learning Principles to Complex Surgical Tasks: Searching for the Optimal Practice Schedule Does warm-up using mental practice improve crisis resource management performance? A simulation study. Visual-spatial ability, learning modality and surgical knot tying. Learning spinal manipulation: the importance of augmented feedback relating to various kinetic parameters. Cognitive skills analysis, kinesiology, and mental imagery in the acquisition of surgical skills. Part Task and Variable Priority Training in First-year Anesthesia Resident Education: A Combined Didactic and Simulation-based Approach to Improve Management of Adverse Airway and Respiratory Events The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Teacher-made models: the answer for medical skills training in developing countries? Structured teaching methods enhance skill acquisition but not problem-solving abilities: an evaluation of the 'silent run through'. Impact of cognitive imaging and sex differences on the development of laparoscopic suturing skills. Efficient implementation of patient-specific simulated rehearsal for the carotid artery stenting procedure: part-task rehearsal. Looking in the mirror: Self-debriefing versus instructor debriefing for simulated crises* A randomised trial comparing a 4-stage to 2-stage teaching technique for laryngeal mask insertion. Impact of Perceptual Ability and Mental Imagery Training on Simulated Laparoscopic Knot-Tying in Surgical Novices Using a Nissen Fundoplication Model Learning to Use Minimal Access Surgical Instruments and 2-Dimensional Remote Visual Feedback: How Difficult is the Task for Novices? Systematically increasing contextual interference is beneficial for learning sport skills The mind’s scalpel in surgical education: a randomised controlled trial of mental imagery Evaluation of distributed practice schedules on retention of a newly acquired surgical skill: a randomized trial. Comparing the effects of physical practice and mental imagery rehearsal on learning basic surgical skills by medical students. Acquisition of psychomotor skills in dentistry: an experimental teaching method. Are two heads better than one? Comparing dyad and self-regulated learning in simulation training. Differential effects of task complexity on contextual interference in a drawing task. The effect of computer navigation on trainee learning of surgical skills. The influence of practice schedules in the learning of a complex bone-plating surgical task. Teaching medical students how to perform a clinical breast examination Learning basic surgical skills with mental imagery: using the simulation centre in the mind. Mental Practice Enhances Surgical Technical Skills: A Randomized Controlled Study Does mental imagery prior to cystoscopy make a difference? A randomized controlled trial. Effectiveness of Two Forms of Feedback on Training of a Joint Mobilization Skill by Using a Joint Translation Simulator
OBJECTIVE To investigate whether a force application of a novel motor skill was simple or complex and to determine the appropriate level of feedback during training . The objective was to determine the effects of various amounts of knowledge of results ( KR ) on learning a novel skill that is frequently taught in chiropractic for the assessment of vertebral motor unit dysfunction . METHODS Thirty-five active subjects were taught the novel skill of spring testing to a particular force range through 9 or 10 teaching sessions over a 2-week period ( a school holiday limited some to only 9 sessions ) . To determine the particular force range , an initial phase of the study involved a licensed and practicing clinician performing motion palpation spring testing of the thoracic spine of a prone subject . The data from a total of 47 pushes throughout the thoracic spine were recorded , and the mean force and st and ard deviation were calculated . The second phase of the study used the obtained mean and st and ard deviation for teaching the force of prone thoracic spine motion palpation to 35 active subjects by administering spring testing to 35 passive subjects . The active subjects were r and omly divided into 4 groups , with each receiving a varying amount of verbal feedback to move toward the target force of their learned skill . Each passive subject was laid prone on an instrumented adjusting table . Group 1 received the least amount of feedback while learning the novel skill . Groups 2 and 3 received more frequent , intermittent feedback while learning the skill , and group 4 received constant , frequent feedback during each of the 10 teaching sessions . All subjects returned within 2 weeks for 2 retention trials to determine the efficacy of the learned skill . RESULTS The mean force determined was 143 N with a st and ard deviation of 14 N. Each subject was taught spring testing within this target range . The 2 final retention trials showed group 3 to have demonstrated the most targeted retention of the learned motor skill . These subjects exhibited the closest force range to the target for the motor skill learned and fewer changes in st and ard deviation compared with their acquisition trials and thus the highest retention . Group 4 , receiving 100 % feedback , demonstrated the most accurate spring testing during the acquisition trials , but the subjects did not effectively demonstrate when compared on acquisition and retention trials . CONCLUSION The results of this study show data to be consistent with the guidance hypothesis in learning a novel motor skill . The constant KR feedback is beneficial for learning when used to reduce error during practice but detrimental when relied upon for retention and learning . These data suggest the necessity of using motor skill development learning theory in the teaching of chiropractic Background Many laparoscopic simulation training systems exist and have been shown to transfer learning of surgical skills to the operating room . The manner in which the training is structured to maximize learning has not been examined . There are many aspects to the acquisition of laparoscopic skills during training , one of which is the availability of knowledge of results ( KR ) . Knowledge of results is information about the outcome of motor skill execution , usually provided to individuals at the end of the execution . The timing and nature of KR can affect how well people learn new motor skills . In addition , detailed instruction during learning can also affect skill acquisition . We studied the effects of KR and instruction on the learning curve of a suturing and knot-tying task . We hypothesized that KR was necessary for skill acquisition , and that detailed instruction would help trainees to learn to perform the task more correctly and reach a performance plateau earlier . In addition , the overall workload of a trainee during training would decrease as skills improved , especially when KR and coaching were provided . Methods Nine medical students with no previous laparoscopic surgical experience were r and omly and evenly divided into three groups with different KR conditions : ( 1 ) no KR , ( 2 ) KR , ( 3 ) KR + instruction . Each subject attended a training session for 1 h each day , 6 days a week for 4 consecutive weeks . Performance measures such as task time , smoothness of instrument , and path length were recorded for each trial . Workload was assessed using the NASA-TLX question naire . Results While KR was necessary for learning to suture , continual instruction had limited additional benefits . However , KR + instruction did reduce subjects ’ perceived overall workload . Conclusions Surgical training could be carried out effectively with only knowledge of results . These results have implication s for the staffing of surgical skills laboratories INTRODUCTION The " 4-stage approach " has been widely accepted for practical skill training replacing the traditional 2 stages ( " see one , do one " ) . However , the superior effectiveness of the 4-stage approach was never proved . OBJECTIVES To evaluate whether skill training with the 4-stage approach results in shorter performance time needed for a successful percutaneous needle-puncture cricothyroidotomy  , and consequently in a reduced number of attempts needed to perform the skill in < 60s compared to traditional teaching . TRIAL DESIGN R and omized controlled single-blinded parallel group study at the University Hospital Bern . METHODS With IRB approval and informed consent 128 undergraduate medical students were r and omized in four groups : traditional teaching , no stage 2 , no stage 3 , and 4-stage approach for the training of cricothyroidotomy .  Everyone watched a video of the cricothyroidotomy as stage 1 followed by skill training in the respective teaching group .  Participants had to perform the cricothyroidotomy 10 times on skin-covered pig larynxes . Performance time was measured from skin palpation to trachea ventilation . Study participants filled out a self-rating on competency during the training . RESULTS Performance time for each attempt was comparable in all groups and improved similarly to reach a performance time of < 60 s. Self-rating revealed that all groups felt equally competent throughout . CONCLUSIONS Even if the 4-stage approach is widely accepted and used as a didactic method for skill teaching we could not find evidence that its use or omitting stage 2 or 3 results in superior learning of an emergency skill compared to traditional teaching Practice of complex tasks can be scheduled in several ways : as whole-task practice or as practice of the individual skills composing the task in either a blocked or a r and om order . The authors used those 3 schedules to study 18 participants ' learning of an orthopedic surgical task .  They assessed learning by obtaining expert evaluation of performance and objective kinematic measures before , immediately after , and 1 week after practice ( transfer test ) . During acquisition , the blocked group showed superior performance for simple skills but not for more complex skills . For the expert-based measures of performance , all groups improved from pretest to posttest and remained constant from posttest to transfer . Measures of the final product showed that the whole- practice group 's outcomes were significantly better than those of the r and om group on transfer . All groups showed better efficiency of motions in the posttest than in the pretest . Those measures were also poorer on the transfer test than on the posttest . The present evidence does not support the context ual interference effect — hypothetically , because of the inherent cognitive effort effect associated with some of the component skills . The authors recommend that surgical tasks composed of several discrete skills be practice d as a whole . The results of this study demonstrate the importance of critically appraising basic theories in applied environments BACKGROUND Mental practice ( MP ) is defined as the ' symbolic rehearsal of a physical activity in the absence of any gross-muscular movements ' and has been used in sport and music to enhance performance . In healthcare , MP has been demonstrated to improve technical skill performance of surgical residents . However , its effect on crisis re source management ( CRM ) skills has yet to be determined . We aim ed to investigate the effect of warm-up with MP on CRM skill performance during a simulated crisis scenario . METHODS Following ethics board approval , 40 anaesthesia residents were r and omized . The intervention group performed 20 min of MP of a script based on CRM principles . The control group received a 20 min didactic teaching session on an unrelated topic . Each subject then managed a simulated cardiac arrest . Two CRM experts rated the video recordings of each performance using the previously vali date d Ottawa GRS . The time to start chest compressions , administer epinephrine , and give blood was recorded . RESULTS There was no significant difference between the intervention and control groups : total Ottawa GRS score was 24.50 ( 18.63 - 28.88 [ 6.50 - 34.50 ] ) ( median ( inter-quartile range [ range ] ) vs 20.50 ( 13.00 - 29.13 [ 6.50 - 34.50 ] ) ( P=0.53 ) ; the time to start chest compressions 146.0 s ( 138.0 - 231.0 [ 115.0 - 323.0 ] ) vs 162.5 s ( 138.0 - 231.0 [ 100.0 - 460.0 ] ) ( P=0.27 ) , the time to epinephrine administration 163.0 s ( 151.0 - 187.0 [ 111.0 - 337.0 ] ) vs 187.0 s ( 164.0 - 244.0 [ 115.0 - 310.0 ] ) ( P=0.09 ) , and the time to blood administration 220.5 s ( 130.8 - 309.0 [ 92.0 - 485.0 ] ) vs 252.5 ( 174.5 - 398.8 [ 65.0 - 527.0 ] ) ( P=0.48 ) . CONCLUSION Unlike technical skills , warm-up with MP does not seem to improve CRM skills in simulated crisis scenarios INTRODUCTION The ability to mentally rotate an object in 3 dimensions has been shown with an individual 's score on the V and enberg and Kuse Mental Rotations Test . The was to determine whether this Mental Rotations Test could be used to predict performance complex surgical skill - the tying of a 1-h and ed surgical reef knot . In addition , we learning a spatially complex surgical skill could be achieved more effectively via a computer-based selfdirected learning approach than with a didactic lecture-based teaching method . METHODS preclerkship medical students at the University of Western Ontario were r and omized into computer-based self-directed learning group and a didactic lecture-style learning group . administration of the Mental Rotations Test , the students were taught how to tie a reef knot via the learning modality assigned to their respective group . RESULTS Students Mental Rotations Test scores were able to tie more surgical knots in the allocated time Students learning how to tie the surgical knot via the computer-based self-directed showed improvement on their knot tying abilities more rapidly than their didactically trained colleagues . CONCLUSION The ability to mentally rotate an object in 3 dimensions played an important initial learning of a spatially complex surgical technical skill . Our data demonstrated learning was as effective and more practical than traditional lecture-based learning BACKGROUND CONTEXT Spinal manipulation is a widely accepted therapeutic approach in the treatment of  back pain .  In st and ard training programs , feedback on student performances is provided by an instructor based on teaching and clinical experience . Systematic study of the type of augmented feedback provided and skill learning is lacking in the literature . PURPOSE The goal of this investigation is to compare the performance of two groups of chiropractic students , one receiving traditional training from experienced instructors , and the other , augmented feedback on specific biomechanical aspects of spinal manipulation therapy using an instrumented manikin . STUDY DESIGN R and omized controlled study . PATIENT SAMPLE Thirty-one fourth-year students from the Department of Chiropractic of Université du Québec à Trois-Rivières participated in this study . OUTCOME MEASURES Kinetic parameters ( force-time curves ) of spinal manipulation were evaluated . METHODS Spinal manipulation parameters were measured before and after a 5-week training period in which one group received st and ard chiropractic training while a second group received augmented feedback about specific biomechanical parameters of spinal manipulation . For both groups , practice scheduling and time duration were similar and consisted of a weekly practice session of 90 minutes for five consecutive weeks . Both groups had to practice thoracic spine manipulation throughout the training period . RESULTS Both groups showed a decrease in peak force applied , with a diminution in the number of trials where a downward incisural point was present in preload force . Participants in the feedback training group significantly reduced their peak force variability and significantly increased their preload force . No significant difference was observed for time to peak force . CONCLUSIONS The results of this study highlight the merits of practicing with an instrumented manikin or other instrumented training aids . Such a device can provide specific feedback on specific parameters of the task during learning ; it can also serve as a tool to assess the progress of students and eliminate the risks relating to repetitive spinal manipulative therapy practice on student colleagues GOAL Isolate and evaluate the impact of mental imagery on the acquisition of an emergency surgical technique . METHOD We studied 44 first-year medical students performing a cricothyrotomy on a mannequin to determine the impact of teaching using mental imagery ( MI ) and /or kinesiology ( KG ) compared to the st and ard Adv and ec Trauma Life Support ( ATLS ) approach . Students were r and omly assigned to one of three groups : MI and KG , KG alone or control ( ATLS ) . Two weeks after the one-hour teaching session , they were evaluated with an OSCE testing the performance of the different steps of the technique , the time required and its fluidity . RESULTS Total results ( maximum : 25 marks ) are as follows : KG + MI = 20.3 + /- 1.5 ; KG = 19.3 + /- 2.9 ; ATLS = 18.2 + /- 2.5 . The only statistically significant difference for total results was in the use of MI and KG compared to the control group . Kinesiology alone or with mental imagery improved the fluidity of the performance . CONCLUSION Many factors influence the acquisition of a surgical technique . This study showed that acquisition and performance of an emergency procedure ( cricothyrotomy ) was improved when mental imagery and kinesiology were combined to teach it Background : Part task training ( PTT ) focuses on dividing complex tasks into components followed by intensive concentrated training on individual components . Variable priority training ( VPT ) focuses on optimal distribution of attention when performing multiple tasks simultaneously with the goal of flexible allocation of attention . This study explored how principles of PTT and VPT adapted to anesthesia training would improve first-year anesthesiology residents ' management of simulated adverse airway and respiratory events . The authors hypothesized that participants with PTT and VPT  would perform better than those with st and ard training . Methods : Twenty-two first-year anesthesia residents were r and omly divided into two groups and trained over 12 months . The control group received st and ard didactic and simulation-based training . The experimental group received similar training but with emphasis on PTT and VPT techniques . Participant ability to manage seven adverse airway and respiratory events were assessed before and after the training period . Performance was measured by the number of correct tasks , making a correct diagnosis , assessment of perceived workload , and an assessment of scenario comprehension . Results : Participants in both groups exhibited significant improvement in all metrics after a year of training . Participants in the experimental group were able to complete more tasks and answered more comprehension questions correctly . There was no difference in perceived workload or the number of correct diagnoses between groups . Conclusion : This study in part confirmed the study hypotheses . The results suggest that VPT and PTT are promising adjuncts to didactic and simulation-based training for management of adverse airway and respiratory events Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background The advantages of using simulators in skills training are generally recognized , but simulators are often too expensive for medical schools in developing countries . Cheaper locally-made models ( or part-task trainers ) could be the answer , especially when teachers are involved in design and production ( teacher-made models , TM ) . Methods We evaluated the effectiveness of a TM in training and assessing intravenous injection skills in comparison to an available commercial model ( CM ) in a r and omized , blind , pretest-posttest study with 144 undergraduate nursing students . All students were assessed on both the TM and the CM in the pre-test and post-test . After the post-test the students were also assessed while performing the skill on real patients . Results Differences in the mean scores pre- and post-test were marked in all groups . Training with TM or CM improved student scores substantially but there was no significant difference in mean scores whether students had practice d on TM or CM . Students who practice d on TM  performed better on communication with the patient than did students who practice d on CM . Decreasing the ratio of students per TM model helped to increase practice opportunities but did not improve student ’s mean scores . The result of the assessment on both the TM and the CM had a low correlation with the results of the assessment on real persons . Conclusions The TM appears to be an effective alternative to CM for training students on basic IV skills , as students showed similar increases in performance scores after training on models that cost considerably less than commercially available models . These models could be produced using locally available material s in most countries , including those with limited re sources to invest in medical education and skills laboratories OBJECTIVES We aim ed to evaluate whether a structured teaching technique ( the silent run through ) was of benefit in the learning of a skill sequence , and whether it would affect students ' ability to improve their problem-solving skills or ability to make judgements . DESIGN Students from one hospital were taught two different complex skills using a highly structured teaching method involving the breakdown of complex tasks into smaller components and the utilization of an internal , silent ' commentary ' . Their subsequent ability to reproduce these skills was compared with a second group of students taught at another hospital . All students were assessed during a common end of attachment Objective Structured Clinical Examination on the two skills , by raters blind to the teaching techniques the students had received . SETTING School of Medicine , University of Leeds , UK . SUBJECTS Medical students . RESULTS Students who received the structured teaching were significantly better at reproducing a complex , sequential clinical skill ( examination of a squint ) . There was no demonstrable improvement in problem-solving skills as assessed on an X-ray interpretation station . Students expressed high levels of satisfaction with learning skills in such a structured way and reported increased confidence in their examination skills . CONCLUSIONS This study provides some evidence to support the hypothesis that different teaching techniques may be more effective for improving different elements of skills learning . In particular , a highly structured technique involving breaking complex tasks down into smaller components and utilizing an internal ' commentary ' may be an effective way of teaching the sequential motor components of complex clinical skills BACKGROUND The introduction of noninvasive laparoscopic surgery has raised concerns about appropriate teaching techniques for medical students considering surgery as a specialization . The principal aim of this study was to determine the effect , between the sexes , of cognitive imaging as a teaching method in the context of learning a surgical technique . METHODS A r and omized treatment-control sample of 42 medical student volunteers was used to test the effect of cognitive imaging on performance and on traditional instructional techniques to help medical students acquire suturing skills specific to laparoscopic surgery . RESULTS Repeated- measures analysis of variance showed no significant effect for the use of cognitive imaging ( F1,40 = 0.97 , p > 0.05 ) . Males tended to perform better than females in completing tasks that required the use of visual-spatial manipulation of the instruments within a simulated laparoscopic environment ( F1,40 = 5.08 , p < 0.05 ) . CONCLUSIONS These results , which are in concordance with other research findings , indicate that females generally have lower visual-spatial abilities than males . Enhanced performance for both sexes , however , increases rapidly with practice . Other than verbal one-on-one instruction , males on average rank instructional approaches that are applied and visual higher than do females OBJECTIVE ( S ) Patient-specific simulated rehearsal ( PsR ) is a technological advance within the domain of endovascular virtual reality ( VR ) simulation . It allows incorporation of patient-specific computed tomography Digital Imaging and Communications in Medicine ( CT DICOM ) data into the simulation and subsequent rehearsal of real patient cases . This study aim ed to evaluate whether a part-task rehearsal ( PTr ) of a carotid artery stenting procedure ( CAS ) on a VR simulator is as effective as a full-task ( FTr ) preoperative run through . METHODS Medical trainees were trained in the CAS procedure and r and omised to a PTr or FTr of a challenging CAS case ( Type-II arch ) . PTr consisted of 30 min of repeated catheterisations of the common carotid artery ( CCA ) . Thereafter , both groups performed the CAS procedure in a fully functional simulated operating suite ( SOS ) with an interventional team . Technical performances were assessed using simulator-based metrics and expert ratings . Other aspects of performance were assessed using the Non-Technical Skills for Surgeons ( NOTSS ) scoring . RESULTS Twenty trainees were evenly r and omised to either PTr or FTr . No differences in performance were seen except for the total time the embolic protection device ( EPD ) was deployed ( 9.4 min for the PT vs. 8.1 min for the FT , p = 0.02 ) . Total time ( 26.3 vs. 25.5 min , p = 0.94 ) , fluoroscopy time ( 15.8 vs. 14.4 min , p = 0.68 ) , number of roadmaps ( 10.5 vs. 11.0 , p = 0.54 ) , amount of contrast ( 53.5 vs. 58.0 ml , p = 0.33 ) , time to deploy the EPD ( 0.9 vs. 0.8 min , p = 0.31 ) and time to catheterise the CCA ( 9.2 vs. 8.9 min , p = 0.94 ) were similar . Qualitative performances as measured by expert ratings ( score 24 vs. 24 , p = 0.49 ) and NOTSS ( p > 0.05 for all categories ) were also comparable . CONCLUSIONS Part- and full-task rehearsals are equally effective with respect to the operative performance of a simulated CAS intervention . This finding makes a patient-specific rehearsal more efficient and may increase the feasibility of implementation of this technology into medical practice Objective : To examine the effectiveness of self-debriefing as compared to instructor debriefing in the change of nontechnical skills performance of anesthesiology residents . Design : Prospect i ve , r and omized , controlled study . Setting : A university hospital simulation center . Subjects : Fifty anesthesiology residents . Interventions : Subjects were instructed in the principles of nontechnical skills for crisis management . Subsequently , each resident participated in a high-fidelity simulated anesthesia crisis scenario ( pretest ) . Participants were r and omized to either a video-assisted self-debriefing or instructor debriefing . In the self-debriefing group , subjects review ed their pretest scenario by themselves , guided by the Anesthetists ' Non-Technical Skills scale . The instructor debriefing group review ed their pretest scenario guided by an expert instructor also using the Anesthetists ' Non-Technical Skills scale as a framework . Immediately following their respective debriefings , subjects managed a second simulated crisis ( post-test ) . Measurements and Main Results : After all data were collected , two blinded experts independently rated videos of all performances in a r and om order using the Anesthetists ' Non-Technical Skills scale . Performance significantly improved from pretest to post-test ( p < .01 ) regardless of the type of debriefing received . There was no significant difference in the degree of improvement between self-debriefing and instructor debriefing ( p = .58 ) . Conclusions : Nontechnical skills for crisis re source management improved with training , as measured by the Anesthetists ' Non-Technical Skills scale . Crisis re source management can be taught , with measurable improvements . Effective teaching of nontechnical skills can be achieved through formative self- assessment even when instructors are not available OBJECTIVE To compare the ' 4-stage ' teaching technique ( demonstration , deconstruction , formulation , performance ) with the traditional ' 2-stage ' teaching technique ( deconstruction , performance ) in  laryngeal mask airway ( LMA ) insertion .  METHODS Using a prospect i ve r and omised study design , participants were taught LMA insertion on a manikin by either the ' 2-stage ' or ' 4-stage ' teaching method .  Subjects were eligible if they had never inserted a LMA .  Skill acquisition was assessed immediately following training , and skill retention assessed a number of weeks later . The primary outcome was  LMA insertion on a manikin , with successful ventilation within 30 s. Other outcomes included overall time to LMA insertion , and number of errors . Assessors were blinded to the teaching method used for each subject . RESULTS A total of 120 participants were r and omised between the two teaching groups ( 60 subjects in each group ) . Mean time to LMA insertion at acquisition was 39.7 s for 2-stage and 34.7 s for 4-stage ( p>0.05 ) , and proportion completing within 30 s was 41.67 % for 2-stage and 48.33 % for the 4-stage teaching group ( p>0.05 ) . With skill retention assessment , mean time to LMA insertion was 44.3 s for 2-stage and 42.5 s for the 4-stage teaching group ( p>0.05 ) . Proportion completing task within 30 s was 34.0 % for 2-stage and 41.67 % for 4-stage group ( p>0.05 ) . Overall , there was no significant difference found in skill acquisition or in skill retention between the 2 or 4-stage teaching method . CONCLUSION The 2-stage teaching technique is not statistically different to the 4-stage teaching method in efficacy of LMA insertion skill acquisition or retention Background : Performing minimally invasive surgery requires training and visual-spatial intelligence . The aim of our study was to examine the impact of visual-spatial perception and additional mental training on the simulated laparoscopic knot-tying task performed by surgical novices . Methods : A total of 40 medical students r and omly assigned to two groups underwent two sessions of laparoscopic basic training on a VR simulator  ( SimSurgery ® , Oslo , Norway ) . The variables time and tip trajectory ( total path length of the instrument tip trajectory ) were used to assess the performance of the intracorporeal knot-tying task using a laparoscopic Nissen fundoplication model . The experimental group completed additional mental practice during the interval between the two training sessions . All performed a cube subtest of a st and ard intelligence test ( I-S-T 2000 R ) to evaluate visual-spatial ability . Results : All participants achieved an improvement in time ( t = 9.861 ; p < 0.001 ) and tip trajectory ( t = 6.833 ; p < 0.001 ) in the second training session . High scores on the visual-spatial test correlated with a faster performance ( r = −0.557 ; p < 0.001 ) and more precise movements ( r = −0.377 ; p = 0.016 ) . Comparison of the two groups did not show any statistical significant differences in the parameters time and tip trajectory . Conclusions : Visual-spatial intelligence tested by a cube test correlated with simulated laparoscopic knot-tying skills in surgical novices . Additional mental practice did not improve the overall knot-tying performance . Further studies are therefore required to determine whether mental practice might be beneficial for experienced laparoscopic surgeons or for more complex tasks Performing minimal access surgery requires the use of 2-dimensional information to produce 3-dimensional movements , as well as precise motor control for manipulating laparoscopic tools . The added visuomotor dem and s of this task make it more dem and ing and complex than traditional open surgery . The purpose of this study was to determine the relative task difficulty of performing  laparoscopic tool movements with normal vision or ` laparoscopic vision ' provided by a remote 2-D monitor . A second purpose of this study was to evaluate whether movement performance changes are induced by practice with normal vision ( NV ) and laparoscopic vision ( LV ) . The study was also design ed to determine whether order of visual condition ( NV or LV ) practice impacts the rate of performance acquisition when transferred to the opposing visual condition . Eleven individuals participated in this study . All subjects performed a bean grasping and a suturing task in two visual conditions : normal vision and laparoscopic vision .  Results revealed that laparoscopic tools themselves do not appear to be problematic in performing minimal access surgery . Furthermore , performance ability in normal vision does not positively transfer to performance when switched to a laparoscopic vision condition . The 2-dimensional video does appear to be problematic for skill acquisition , as performance levels decreased as complexity of the task increased Abstract To better underst and the context ual interference effect , in two experiments we investigated a form of practice schedule that provided novices with systematic increases in context ual interference . This new type of practice schedule was compared with traditional blocked and r and om scheduling for two types of sports skills . In Experiment 1 , we tested the hypothesis that practising variations of the same task with systematic increases in context ual interference would lead to superior performance compared with blocked or r and om scheduling .  Participants practised  golf putting tasks following a blocked , r and om or increasing schedule , which involved initial blocked trials , followed by serial practice trials , and ended with r and om scheduling .  Participants who followed the increasing schedule had superior retention test performance . In Experiment 2 , we tested if these learning benefits were observed when learning tasks controlled by different generalized motor programs . Participants practised three different basketball passes ( chest , overhead , single arm ) in a blocked , r and om or increasing schedule . Participants practising with gradual increases in context ual interference performed better on retention and transfer tests than participants practising with blocked or r and om scheduling . The results of these two experiments indicate that a practice schedule offering systematic increases in context ual interference facilitates skill learning Please cite this paper as : Geoffrion R , Gebhart J , Dooley Y , Bent A , D and olu V , Meeks R , Baker K , Tang S , Ross S , Robert M. The mind ’s scalpel in surgical education : a r and omised controlled trial of mental imagery . BJOG 2012;119:1040–1048 BACKGROUND practice influences new skill acquisition . The aim of this study was to prospect ively investigate the impact of practice distribution ( weekly vs monthly ) on complex motor skill ( end-side vascular  anastomosis ) acquisition and 4-month retention . METHODS twenty-four surgical interns were r and omly assigned to weekly training for 4 weeks or monthly training for 4 months , with equal total training times . Performance was assessed before training , immediately after training , after the completion of distributed training , and 4 months later . RESULTS there was no statistical difference in surgical skill acquisition and retention between the weekly and monthly scheduled groups , as measured by procedural checklist scores , global rating scores of operative performance , final product analysis , and overall performance or assessment of operative " competence . " CONCLUSIONS distributed practice results in improvement and retention of a newly acquired surgical skill independent of weekly or monthly practice schedules . Flexibility in a surgical skills laboratory curriculum is possible without adversely affecting training OBJECTIVE The purpose of this study was to test the effects of varying the amount of physical practice and mental imagery rehearsal on learning basic surgical procedures . STUDY DESIGN Using a sample of 65 second-year medical students , 3 r and omized groups received either : ( 1 ) 3 sessions of physical practice on suturing a pig 's foot ; ( 2 ) 2 sessions of physical practice and 1 session of mental imagery rehearsal ; or ( 3 ) 1 session of physical practice and 2 sessions of imagery rehearsal . All participants then performed a surgery on a live rabbit in the operating theater of a veterinary college under approved conditions . Analysis of variance was applied to pre- and post-treatment ratings of surgical performance . RESULTS Physical practice followed by mental imagery rehearsal was statistically equal to additional physical practice .  CONCLUSION Initial physical practice followed by mental imagery rehearsal may be a cost-effective method of training medical students in learning basic surgical skills Acquisition of psychomotor skills is one of the most important educational tasks in dental education ; yet , there has been little systematic research in this area . This investigation compared a traditional method of teaching psychomotor skills with an experimental method . The investigation was conducted in a pre clinical restorative dentistry laboratory course . Eighty-eight freshman students were r and omly assigned to an experimental ( n = 44 ) or control group ( n = 44 ) ; instructors ( n = 4 ) were r and omly assigned to each group . The control group was taught using the traditional method used at the University of North Carolina School of Dentistry at Chapel Hill ; the experimental group was taught using a guided systematic approach that relied on detailed checklists and exhaustive faculty feedback . Dependent variables measured were quality of performance on laboratory practical examinations , time required to complete practical examinations , and time required to complete the course . Results suggest that this experimental approach has promise for psychomotor skill teaching and learning in dentistry CONTEXT The optimal learner to simulator ratio for procedural skills training is not known . Research in motor learning suggests observational training in pairs , termed ' dyad training ' , may be as effective as directed self-regulated learning ( DSRL ) . OBJECTIVES This study was conducted to compare the relative effectiveness and efficiency of dyad versus DSRL training of simulation-based lumbar puncture ( LP ) . METHODS We conducted a two-group r and omised equivalence trial . First-year internal medicine residents ( n = 50 ) were r and omly assigned to learn LP either in dyads or as individual learners on a simulator , using a directed self-regulated approach ( i.e. the learning sequence was defined for them , but they defined the pace of learning ) . Participants were videotaped performing a simulated LP on a pre-test , an immediate post-test , and a 6-week delayed retention test . In duplicate , blinded raters independently evaluated all trainee performances using a previously vali date d 5-point global rating scale ( GRS ) and 35-item checklist . RESULTS Our analyses showed no significant differences ( p = 0.69 ) on pre-test , post-test or retention test GRS scores between the dyad ( mean ± st and ard deviation [ SD ] scores by test : 2.39 ± 0.57 , 3.48 ± 0.62 , 3.12 ± 0.85 , respectively ) and DSRL ( mean ± SD scores by test : 2.67 ± 0.50 , 3.34 ± 0.77 , 3.21 ± 0.79 , respectively ) groups . Both groups improved significantly from pre-test to post-test ( p < 0.001 ) and retained that performance following the 6-week delay . Dyad participants experienced significantly greater pre-test to post-test gains than DSRL participants ( p = 0.02 ) . There was no significant difference in total practice time between the groups ( 20.94 minutes for individuals and 24.20 minutes for dyads ; p = 0.175 ) . CONCLUSIONS Our results indicate that learning in pairs is as effective as independent DSRL . Dyad training permits the more efficient use of simulators as two learners use the same re sources as an individual A large number of studies demonstrated the beneficial effects of context ual interference ( CI ) created by a r and om practice of different task variations during training on the retention and transfer of motor skills . Current interpretations of this phenomenon assume that r and om practice engages the subjects in deep and elaborate processing of movement related information , whereas blocked practice results in more superficial processing leading to poorer performance on later retention and transfer tests . According to this line of interpretation , we hypothesised that the complexity of the task to be learned could modulate the effects of CI . If the task is sufficiently complex , it could force the subjects to rely on such elaborate processing , and the beneficial effects of the intertask interference created by r and om practice could be obscured in that case . We tested this hypothesis by analysing the effects of practice schedule ( r and om vs. blocked ) , on the acquisition , retention and transfer of learning in a drawing task where subjects had to reproduce accurately , without visual control , geometrical patterns presented on a video screen , as a function of task complexity defined by the number of segments ( two , three or four ) of each pattern . The results indicated a clear beneficial effect of r and om over blocked practice on delayed retention and transfer . However , this CI effect was only observed in subjects who learned the simplest movements , and was not observed in subjects who practised the more complex task . These results are discussed in terms of intratask interference created by the planning of multiple movements and the processing of knowledge of results ( KR ) when the number of drawing movements is increased . These findings support the assumption that the level of cognitive effort in which the subjects are engaged during training is a main factor influencing long-term retention and transfer of motor skills BACKGROUND While computer-assisted orthopaedic surgery technology may facilitate performance and learning in the expert , its effects on the trainee are unclear . Motor learning theory suggests that , while the real-time feedback provided by computer-assisted orthopaedic surgery should improve performance , it may be detrimental to learning . The purpose of this study was to assess the effects of computer-assisted orthopaedic surgery on the learning of surgical skills by trainees . METHODS Forty-five participants were r and omized to one of three training groups-conventional training , computer navigation , or knowledge of results -in which they learned technical skills related to total hip replacement .  Outcomes were assessed in a pretest session and in ten-minute and six-week retention and transfer tests . RESULTS All groups demonstrated improved accuracy and precision in the determination of the abduction angle and the version angle of the acetabular cups during training ( p < 0.001 ) . The computer navigation group demonstrated significantly better accuracy and precision in early training ( p < 0.05 ) and better precision throughout training ( p < 0.05 ) . No significant degradation in performance was observed between the immediate and the delayed testing for any group , suggesting that there was task learning in all groups with no negative effects of the tested training modalities on learning . CONCLUSIONS In this study , the concurrent augmented feedback provided by computer-assisted orthopaedic surgery result ed in improved early performance and equivalent learning . While we did not observe a compromise in learning , further investigation is required to ensure that computer-assisted orthopaedic surgery does not compromise trainee learning in more complex tasks BACKGROUND Practicing surgical tasks on  bench models can be arranged in 3 ways : as the entire task , or as individual skills practice d separately in blocked or r and om order . The issue of the optimal practice schedule for the acquisition of surgical tasks is critical for enhancing training programs . METHOD An  orthopedic bone-plating task  was practice d as a whole , or in parts in either a r and om or a blocked order .  Learning was assessed on global ratings , checklists , and final product analysis before , immediately after , and an hour after practice . RESULTS Checklists , and final product analysis , but not the global ratings showed that practicing the entire task result ed in the most learning , followed by the r and om practice . Practice of the skills in a blocked order yielded the least amount of learning . CONCLUSIONS It is recommended that surgical tasks composed of several discrete skills should be practice d as a whole . However , if part practice is necessary , these skills should be arranged in r and om order to optimize learning BACKGROUND . One challenge in medical education is to provide training in physical examination skills . The authors conducted a r and omized study to compare st and ardized and unst and ardized methods of teaching clinical breast examinations and to determine whether trained non-medical women could teach as well as medical faculty . METHOD . Sensitivity , specificity , and examination techniques were compared between first-year students at the University of Calgary Faculty of Medicine who in 1992–93 received st and ardized teaching from family medicine faculty or well women teachers and 70 second-year students who received unst and ardized teaching during their clinical rotations .  St and ardized teaching included a specific examination technique using silicone breast models . The students taught by the well women teachers also examined the women 's breasts . RESULTS . The st and ardized-teaching group had more consistent examination techniques and significantly higher sensitivity but lower specificity . The students taught by the well women teachers performed as well as those taught by the family medicine faculty . CONCLUSIONS . The teaching methods used by trained teachers and st and ardized models improved the students'accuracy of breast lump detection and examination skills CONTEXT Although surgeons and athletes frequently use mental imagery in preparing to perform , mental imagery has not been extensively research ed as a learning technique in medical education . OBJECTIVE A mental imagery rehearsal technique was experimentally compared with textbook study to determine the effects of each on the learning of basic surgical skills . METHODS Sixty-four Year 2 medical students were r and omly assigned to 2 treatment groups in which they undertook either mental imagery or textbook study . Both groups received the usual skills course of didactic lectures , demonstrations , physical practice with pigs ' feet and a live animal laboratory . One group received additional training in mental imagery and the other group was given textbook study .  Performance was assessed at 3 different time-points using a reliable rating scale . RESULTS Analysis of variance on student performance in live rabbit surgery revealed a significant interaction favouring the imagery group over the textbook study group . CONCLUSIONS The mental imagery technique appeared to transfer learning from practice to actual surgery better than textbook study OBJECTIVE To assess the effects of mental practice on surgical performance . BACKGROUND Increasing concerns for patient safety have highlighted a need for alternative training strategies outside the operating room . Mental practice ( MP ) , " the cognitive rehearsal of a task before performance , " has been successful in sport and music to enhance skill . This study investigates whether MP enhances performance in laparoscopic surgery . METHODS After baseline skills testing , 20 novice surgeons underwent training on an evidence -based virtual reality curriculum .  After r and omization using the closed envelope technique , all participants performed  5 Virtual Reality ( VR ) laparoscopic cholecystectomies ( LC ) . Mental practice participants performed 30 minutes of MP before each LC ; control participants viewed an online lecture .  Technical performance was assessed using video Objective Structured Assessment of Technical Skills-based global ratings scale ( scored from 7 to 35 ) . Mental imagery was assessed using a previously vali date d Mental Imagery Question naire . RESULTS Eighteen participants completed the study . There were no intergroup differences in baseline technical ability . Learning curves were demonstrated for both MP and control groups . Mental practice was superior to control ( global ratings ) for the first LC ( median 20 vs 15 , P = 0.005 ) , second LC ( 20.5 vs 13.5 , P = 0.001 ) , third LC ( 24 vs 15.5 , P < 0.001 ) , fourth LC ( 25.5 vs 15.5 , P < 0.001 ) and the fifth LC ( 27.5 vs 19.5 , P = 0.00 ) . The imagery for the MP group was also significantly superior to the control group across all sessions ( P < 0.05 ) . Improved imagery significantly correlated with better quality of performance ( ρ 0.51–0.62 , Ps < 0.05 ) . CONCLUSIONS This is the first r and omized controlled study to show that MP enhances the quality of performance based on VR laparoscopic cholecystectomy . This may be a time- and cost-effective strategy to augment traditional training in the OR thus potentially improving patient care OBJECTIVE We sought to determine whether mental imagery improves surgical performance of residents novice to cystoscopy . STUDY DESIGN We performed a multicenter r and omized controlled trial . Residents who had performed < or = 3 cystoscopies were r and omized to preoperative mental imagery sessions or reading a book chapter describing cystoscopy . The primary outcome was comparison of groups ' surgical performance scores . Secondary outcomes were measurements of operative times and resident ratings of helpfulness of their preparation . Scores were compared using 2-factor analysis of variance . RESULTS In all , 68 residents were r and omized ; 33 to imagery and 35 to control groups . Groups did not differ in age , cystoscopic experience , residency level , or sex . The imagery group 's surgical assessment scores were 15.9 % higher than controls ( P = .03 ) . Operative times did not differ between groups . Imagery residents rated  imagery preparation as more helpful than controls ( P < .0001 ) . CONCLUSION Residents considered mental imagery to be a more useful preoperative preparation . The mental imagery group 's surgical performance was superior to controls Background and Purpose Joint mobilization is a complicated task to learn and to teach and is characterized by great intersubject variability . This study 's purpose was to investigate whether quantitatively augmented feedback could enhance the learning of joint mobilization and , more specifically , to compare the effects of training with concurrent or terminal feedback by using a joint translation simulator ( JTS ) . Subjects Thirty-six undergraduate physical therapist students were r and omly assigned to control ( no feedback ) , concurrent feedback , and terminal feedback groups . Methods The JTS was design ed to simulate tissue resistance based on load-displacement relationships of glenohumeral joint specimens . Subjects applied specific mobilization grade s of force on the JTS while quantitative feedback was given to the feedback groups either during a trial ( ie , concurrent feedback ) or after a trial ( ie , terminal feedback ) . The skill acquisition phase lasted a total of 40 minutes , and a total of 75 repetitions were performed for each grade of each joint model . Pretest and no-feedback retention tests were conducted . Results During acquisition and retention , both feedback groups performed more accurately than did the control group . No obviously superior performance was shown by the terminal feedback group compared with concurrent feedback group during retention testing . Discussion and Conclusion Subjects who trained with augmented feedback had less variability , and thus more consistency , than the control group subjects who received no feedback . Augmented feedback provides the student with a reference force and the status of his or her performance . The effectiveness of the JTS feedback compared with no feedback was clearly demonstrated . Skill acquisition in mobilization can be enhanced by either concurrent or terminal feedback
Background Learning of procedural skills is an essential component in the education of future health professionals .
There is little evidence on how procedural skills are best learnt and practice d in education .
There is a need for educators to know what specific interventions could be used to increase learning of these skills .
However , there is growing evidence from rehabilitation science , sport science and psychology that learning can be promoted with the application of motor learning principles .
The aim of this review was to systematic ally evaluate the evidence for selected motor learning principles in physiotherapy and medical education .