Examining the Efficacy of a Novel Mental Skills Curriculum Implemented with Surgical Novices

Nicholas E Anton, MS1, Lisa D Howley, PhD1, Manuel E Pimentel, BS1, Cameron K Davis, BA1, Charles Brown, PhD2, Dimitrios Stefanidis, MD, PhD3. 1Carolinas Simulation Center, Carolinas HealthCare System, Charlotte, NC, 2Head in the Game Inc, Charlotte, NC, 3Department of Surgery, Carolinas HealthCare System, Charlotte, NC

Introduction: Stress has been shown to negatively impact surgical performance. Surgical novices are more susceptible than experts to experience intraoperative stress. Mental skills are psychological strategies that enhance performance and reduce stress, and have been routinely implemented in other domains (e.g., military, elite athletics, etc.) to optimize performance. The purpose of this study was to develop a novel mental skills curriculum (MSC) to reduce surgical novices’ stress and increase their use of mental skills.

Methods and Procedures: After the initial development and refinement process, the MSC was implemented with a convenience sample of surgical novices during their 8-week fundamentals of laparoscopic surgery (FLS) training. Participants’ state (i.e., emotional state at a moment in time) and trait (i.e., proneness to stress) anxiety was measured at baseline and post-test with the State-Trait Anxiety Inventory (STAI-F), and their use of  mental skills during performance was captured with a modified version of the previously validated Test of Performance Strategies (mTOPS-3). A paired T-test was used to analyze the results.

Results: Nine novices (age 23 ±7 years, 55% women) completed the MSC. Their FLS performance was significantly improved after training (Objective suturing score was 13.33 at baseline, 424.88 at post-test; p<.001). There was a significant reduction in state and trait anxiety and increase in the use of mental skills by participants at post-test compared with baseline (see table).

Conclusion: The novel MSC developed and implemented in this study was effective at reducing surgical novices’ anxiety and increasing their use of mental skills. This curriculum may be valuable to help surgical trainees reduce intraoperative stress and increase their use of performance enhancing strategies, which could ultimately increase patient safety in the operating room. Additional research on the effectiveness of this curriculum is currently underway at our institution.

STAI-State Anxiety*41.1132.11p<.05
STAI-Trait Anxiety*45.7840.56p<.001
Positive Self-Talk+3.194.19p<.01
Emotional Control+2.833.47p<.01
Mental Imagery+3.924.44p<.01
Attention Control+2.943.67p<.05

*- Lower scores indicate lower stress;

+ – Higher scores indicate more use of mental skills

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