P123: Mental practice for technical skills training in emergency medicine: a scoping review

Abstract

Introduction: Emergency physicians must achieve and maintain competence in numerous procedural skills, many of which are high stakes, time dependent, and used infrequently in clinical practice. Mental practice (MP) is the systematic use of mental imagery to see and feel an action in ones imagination without engaging in actual physical movement, and has been shown to enhance skill acquisition and performance in music and athletics. In this scoping review, we describe the utility and effectiveness of MP as a tool for procedural skill acquisition in medicine. Methods: An electronic search of MEDLINE, EMBASE, the Cochrane Library, CINAHL, PsycINFO, Open Grey, Conference Proceedings Index, ProQuest Dissertations and Theses and Google Scholar was conducted. Included studies evaluated MP for learning medically related technical skills using any method of mental training (script memorization, hypo-therapy, psychotherapy). Two independent reviewers screened articles for inclusion, and data was extracted using a standardized tool. Results: Our search returned 2028 results, of which 61 were eligible for inclusion. Forty-three studies evaluated MP interventions for technical skill development. Of these, 69.6% focused on minimally invasive surgical skills. The most common outcome measure was quantitative evaluation of skill via observer-scored checklist (69.6%). Other outcomes included stress, time to task completion, and haptic and movement data from surgical simulators. 82.6% of studies demonstrated a positive effect of MP on skill acquisition or performance. The quality of the trials was modest, and only 34.7% of published work provided clear detail on specific MP strategies. Conclusion: MP is an effective tool for procedural skills training. Areas outside of minimally invasive surgery are under-represented, and more data is needed on MP for rare or emergent procedures that typify emergency care. The minority of studies reviewed reported methods for developing and validating MP interventions in sufficient detail, a practice that should be adopted in future trials.